Provider Demographics
NPI:1508348541
Name:RAYCROFT, AUDREY WOODHAM (LICSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:WOODHAM
Last Name:RAYCROFT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:SHERBORN
Mailing Address - State:MA
Mailing Address - Zip Code:01770-1526
Mailing Address - Country:US
Mailing Address - Phone:508-651-3634
Mailing Address - Fax:
Practice Address - Street 1:18 EVERETT ST
Practice Address - Street 2:
Practice Address - City:SHERBORN
Practice Address - State:MA
Practice Address - Zip Code:01770-1526
Practice Address - Country:US
Practice Address - Phone:508-651-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1074771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical