Provider Demographics
NPI:1932223070
Name:RAIMONDI, COSMAS L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:COSMAS
Middle Name:L
Last Name:RAIMONDI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 N MERIDIAN ST
Mailing Address - Street 2:SUITE A9
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1878
Mailing Address - Country:US
Mailing Address - Phone:317-581-1779
Mailing Address - Fax:317-581-1781
Practice Address - Street 1:9135 N MERIDIAN ST
Practice Address - Street 2:SUITE A9
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1878
Practice Address - Country:US
Practice Address - Phone:317-581-1779
Practice Address - Fax:317-581-1781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001977A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264600Medicare ID - Type Unspecified