Provider Demographics
NPI:1629716725
Name:CARTER, RAYMOND R (CPSS)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:R
Last Name:CARTER
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2803
Mailing Address - Country:US
Mailing Address - Phone:347-659-0291
Mailing Address - Fax:
Practice Address - Street 1:127 W FIFTH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3707
Practice Address - Country:US
Practice Address - Phone:859-523-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1186252175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist