Provider Demographics
NPI:1740215094
Name:RAYMON, RUTH A (MED LSW)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:A
Last Name:RAYMON
Suffix:
Gender:F
Credentials:MED LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 WESTWOOD LANE
Mailing Address - Street 2:2ND FL
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-645-5638
Mailing Address - Fax:
Practice Address - Street 1:1405 WESTWOOD LANE
Practice Address - Street 2:2ND FL
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-645-5638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004473L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P69764Medicare UPIN
063277Medicare ID - Type Unspecified