Provider Demographics
NPI:1841419546
Name:WORMACK, RAYMOND DANIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DANIEL
Last Name:WORMACK
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 1:201 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3703
Mailing Address - Country:US
Mailing Address - Phone:724-626-2171
Mailing Address - Fax:724-620-0915
Practice Address - Street 1:201 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3703
Practice Address - Country:US
Practice Address - Phone:724-626-2171
Practice Address - Fax:724-620-0915
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124221104100000X
CW0181141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker