Provider Demographics
NPI:1972247930
Name:RAYMOND, MATTHEW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:RAYMOND
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 1:1495 CHAIN BRIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5727
Mailing Address - Country:US
Mailing Address - Phone:202-262-2010
Mailing Address - Fax:
Practice Address - Street 1:1495 CHAIN BRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5727
Practice Address - Country:US
Practice Address - Phone:703-598-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904013251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904013251OtherNON-MEDICARE