Provider Demographics
NPI:1104538313
Name:RAYMOND, NAOMI (LMHC, LPMT, LCAT)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:LMHC, LPMT, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5700
Mailing Address - Country:US
Mailing Address - Phone:401-648-7172
Mailing Address - Fax:
Practice Address - Street 1:845 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5700
Practice Address - Country:US
Practice Address - Phone:401-648-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05-P112953-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05-P112953-01OtherPERMIT