Provider Demographics
NPI:1386143923
Name:RAYMOND, ERIN LINDSEY (MSW)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LINDSEY
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LINDSEY
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 CIBOLA DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-3270
Mailing Address - Country:US
Mailing Address - Phone:407-866-8356
Mailing Address - Fax:
Practice Address - Street 1:1203 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3721
Practice Address - Country:US
Practice Address - Phone:407-277-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW111941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL802045726Medicaid
FL805039667Medicaid