Provider Demographics
NPI:1750747614
Name:FIERRO, RAYMOND (MA COUNSELING IN EDU)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:FIERRO
Suffix:
Gender:M
Credentials:MA COUNSELING IN EDU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 CAMDEN AVE STE 5A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2845
Mailing Address - Country:US
Mailing Address - Phone:669-300-6946
Mailing Address - Fax:669-300-6936
Practice Address - Street 1:1790 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5424
Practice Address - Country:US
Practice Address - Phone:408-377-0377
Practice Address - Fax:408-377-0373
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health