=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730426602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. CHARLYNN MERCEDES RAYMOND-ORTIZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2013
-----------------------------------------------------
Last Update Date | 01/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7426 NEWCASTLE GOLF CLUB RD # 4C
-----------------------------------------------------
City | NEWCASTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98059-9146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-941-8262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7426 NEWCASTLE GOLF CLUB ROAD 4C
-----------------------------------------------------
City | NEWCASTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-941-8262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3754
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------