Provider Demographics
NPI:1730426602
Name:RAYMOND-ORTIZ, CHARLYNN MERCEDES
Entity type:Individual
Prefix:MS
First Name:CHARLYNN
Middle Name:MERCEDES
Last Name:RAYMOND-ORTIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHARLYNN
Other - Middle Name:MERCEDES
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:7426 NEWCASTLE GOLF CLUB ROAD
Mailing Address - Street 2:4C
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059
Mailing Address - Country:US
Mailing Address - Phone:425-941-8262
Mailing Address - Fax:
Practice Address - Street 1:7426 NEWCASTLE GOLF CLUB RD # 4C
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-9146
Practice Address - Country:US
Practice Address - Phone:425-941-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI37541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000OtherUPIN