Provider Demographics
NPI:1972841666
Name:RIBEIRO, RAOUL ANTHONY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RAOUL
Middle Name:ANTHONY
Last Name:RIBEIRO
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 1:115 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-9426
Mailing Address - Country:US
Mailing Address - Phone:406-827-0345
Mailing Address - Fax:
Practice Address - Street 1:115 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-9426
Practice Address - Country:US
Practice Address - Phone:406-827-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC-44191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT$$$$$$$$$Medicaid