Provider Demographics
NPI:1205425816
Name:RAYMOND-GUTIERREZ, MINDY (LSW)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:RAYMOND-GUTIERREZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CREVELING RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08804-6001
Mailing Address - Country:US
Mailing Address - Phone:347-525-1727
Mailing Address - Fax:
Practice Address - Street 1:9 CREVELING RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURY
Practice Address - State:NJ
Practice Address - Zip Code:08804-6001
Practice Address - Country:US
Practice Address - Phone:347-525-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135728104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker