Provider Demographics
NPI:1780207407
Name:RAYNOR, THOMAS TOD (CADC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:TOD
Last Name:RAYNOR
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 FIRST RANGEWAY
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5254
Mailing Address - Country:US
Mailing Address - Phone:207-616-0705
Mailing Address - Fax:
Practice Address - Street 1:70 FIRST RANGEWAY
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5254
Practice Address - Country:US
Practice Address - Phone:207-616-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC7066101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESSA684134Medicaid