Provider Demographics
NPI:1659515260
Name:TAYLOR, RAYMOND JOHN (PHD MSW)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOHN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 O'CONNELL BOULEVARD
Mailing Address - Street 2:SOLDIER READINESS PROCESSING CENTER (SRC) BUILDING 1056
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-524-1385
Mailing Address - Fax:
Practice Address - Street 1:1853 OCONNELL BLVD
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4055
Practice Address - Country:US
Practice Address - Phone:719-524-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9897871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical