Provider Demographics
NPI:1962929737
Name:ST-GERMAIN, RAYMOND JAMES III (LCSW)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JAMES
Last Name:ST-GERMAIN
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BROADFIELD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5162
Mailing Address - Country:US
Mailing Address - Phone:281-906-7134
Mailing Address - Fax:718-640-2713
Practice Address - Street 1:1400 BROADFIELD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5162
Practice Address - Country:US
Practice Address - Phone:281-906-7134
Practice Address - Fax:718-640-2713
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX325421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32542OtherSTATE LICENSE