Provider Demographics
NPI:1952452732
Name:LEDOUX, RAYMOND C (LICSW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:C
Last Name:LEDOUX
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-1310
Mailing Address - Country:US
Mailing Address - Phone:413-625-2613
Mailing Address - Fax:
Practice Address - Street 1:62 RIDDELL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2002
Practice Address - Country:US
Practice Address - Phone:413-625-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1056171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21232Medicare ID - Type Unspecified