1275669624 NPI number — MS. SUSAN KIMBERLY JONES RAYMOND LICSW

Table of content: MS. SUSAN KIMBERLY JONES RAYMOND LICSW (NPI 1275669624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275669624 NPI number — MS. SUSAN KIMBERLY JONES RAYMOND LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES RAYMOND
Provider First Name:
SUSAN
Provider Middle Name:
KIMBERLY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
SUSAN
Provider Other Middle Name:
KIMBERLY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275669624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 CHANNELL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGAWAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-789-0125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 RIVERDALE STREET
Provider Second Line Business Practice Location Address:
BRIGHTSIDE INC
Provider Business Practice Location Address City Name:
WEST SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-748-9999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1027626 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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