Provider Demographics
NPI:1558534347
Name:PLAMONDON, RAYMOND ALVIN (CAS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ALVIN
Last Name:PLAMONDON
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5124
Mailing Address - Country:US
Mailing Address - Phone:831-476-1747
Mailing Address - Fax:831-476-1362
Practice Address - Street 1:749 37TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-5124
Practice Address - Country:US
Practice Address - Phone:831-476-1747
Practice Address - Fax:831-476-1362
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA440012APOtherSTATE CERTIFICATION