Provider Demographics
NPI:1295174092
Name:RAYNOR-MCCLANAHAN, CAROLYN D (MSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:D
Last Name:RAYNOR-MCCLANAHAN
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7694
Mailing Address - Country:US
Mailing Address - Phone:573-747-7924
Mailing Address - Fax:
Practice Address - Street 1:502 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-3720
Practice Address - Country:US
Practice Address - Phone:573-747-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012026563104100000X
MO20140425021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker