Provider Demographics
NPI:1194087981
Name:WEBSTER-RAYMOND, KELLY J (LMSW-CC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:WEBSTER-RAYMOND
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 COMMERCIAL ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4254
Mailing Address - Country:US
Mailing Address - Phone:207-470-7090
Mailing Address - Fax:207-470-7094
Practice Address - Street 1:731 COMMERCIAL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4254
Practice Address - Country:US
Practice Address - Phone:207-470-7090
Practice Address - Fax:207-470-7094
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC132451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical