Provider Demographics
NPI:1366857179
Name:RAIMUNDO, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:RAIMUNDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20721 SW 116TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1039
Mailing Address - Country:US
Mailing Address - Phone:786-307-5089
Mailing Address - Fax:
Practice Address - Street 1:20721 SW 116TH RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189
Practice Address - Country:US
Practice Address - Phone:786-307-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6071103K00000X
FLRBT-18-56688106S00000X
171M00000X
FL1-21-50160103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator