Provider Demographics
NPI:1629518840
Name:SMITH, RAYMOND (LCSW-C, QCSW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW-C, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10530 CAMPUS WAY S # 1025
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1309
Mailing Address - Country:US
Mailing Address - Phone:667-299-6185
Mailing Address - Fax:
Practice Address - Street 1:10 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1812
Practice Address - Country:US
Practice Address - Phone:508-580-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040141041C0700X
WY15401041C0700X
DCLC500827181041C0700X
NCC0140481041C0700X
MD196991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical