Provider Demographics
NPI:1265910798
Name:MCPHIE, RAYMOND MICHAEL (LICSW)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MICHAEL
Last Name:MCPHIE
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 1:3011 SAMOSA HILL CIR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-4936
Mailing Address - Country:US
Mailing Address - Phone:352-708-4120
Mailing Address - Fax:
Practice Address - Street 1:3011 SAMOSA HILL CIR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-4936
Practice Address - Country:US
Practice Address - Phone:352-708-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM210-733-51-287-0OtherDRIVERS LICENSE