Provider Demographics
NPI:1730903659
Name:LANDRY, RAYMOND (MSW, ACSW)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:LANDRY
Suffix:
Gender:M
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-3701
Mailing Address - Country:US
Mailing Address - Phone:925-491-7675
Mailing Address - Fax:
Practice Address - Street 1:1225 FALLON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-4278
Practice Address - Country:US
Practice Address - Phone:510-272-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1224411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA122441OtherBOARD OF BEHAVIORAL SCIENCE