Provider Demographics
NPI:1982884912
Name:SHUMWAY, RAYMOND DIRK (LCSW)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:DIRK
Last Name:SHUMWAY
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:PO BOX 4752
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0197
Mailing Address - Country:US
Mailing Address - Phone:541-500-8655
Mailing Address - Fax:800-433-1396
Practice Address - Street 1:1040 CRATER LAKE AVE STE D
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6295
Practice Address - Country:US
Practice Address - Phone:435-216-6073
Practice Address - Fax:800-433-1396
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL64331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical