Provider Demographics
NPI:1598857369
Name:RAYMER, MARY A (LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:RAYMER
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:MI
Mailing Address - Zip Code:49610-0105
Mailing Address - Country:US
Mailing Address - Phone:231-938-9610
Mailing Address - Fax:231-938-9818
Practice Address - Street 1:6652 DEEPWATER POINT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9247
Practice Address - Country:US
Practice Address - Phone:231-938-9610
Practice Address - Fax:231-938-9818
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI41010054461041C0700X
MI6801016881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0890494Medicare ID - Type UnspecifiedPROVIDER NUMBER