Provider Demographics
NPI:1396407326
Name:RAYMONDI, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RAYMONDI
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 1:1201 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4283
Mailing Address - Country:US
Mailing Address - Phone:330-244-8782
Mailing Address - Fax:
Practice Address - Street 1:1201 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4283
Practice Address - Country:US
Practice Address - Phone:330-244-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303831101YP2500X, 101YM0800X
LICDC.162626101YA0400X
OHC.2103800101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.2103800OtherCOUNSELOR, SOCIAL WORKER AND MARRIAGE AND FAMILY THERAPIST BOARD
OHE.2303831OtherCOUNSELOR, SOCIAL WORKER AND MARRIAGE AND FAMILY THERAPIST BOARD
OHLICDC.162626OtherCHEMICAL DEPENDENCY PROFESSIONALS BOARD