Provider Demographics
NPI:1689733578
Name:FORD, RAYMOND MONTE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:MONTE
Last Name:FORD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1778
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-1636
Mailing Address - Country:US
Mailing Address - Phone:805-534-3943
Mailing Address - Fax:
Practice Address - Street 1:4555 EL CAMINO REAL
Practice Address - Street 2:SUITE G
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-2700
Practice Address - Country:US
Practice Address - Phone:805-534-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS151771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical