Provider Demographics
NPI:1720880230
Name:PAMILTON, RAYNARD
Entity type:Individual
Prefix:
First Name:RAYNARD
Middle Name:
Last Name:PAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 CASTERBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-1768
Mailing Address - Country:US
Mailing Address - Phone:209-276-4994
Mailing Address - Fax:
Practice Address - Street 1:9131 CASTERBRIDGE DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-1768
Practice Address - Country:US
Practice Address - Phone:209-276-4994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1060241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical