Healthcare Provider Details

I. General information

NPI: 1407932148
Provider Name (Legal Business Name): RAYMOND ALAN BEDGOOD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 N CANAL ST
CARLSBAD NM
88220-5110
US

IV. Provider business mailing address

1826 VETERANS BLVD SATP/MHSL (1165)
DUBLIN GA
31021-3620
US

V. Phone/Fax

Practice location:
  • Phone: 505-885-4836
  • Fax: 505-887-9579
Mailing address:
  • Phone: 478-272-1210
  • Fax: 478-277-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-06419
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: