MEDICARE: MR. RAYMUNDO D FERMIN LMSW, CASAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	72 085328	NY

General Provider Information

NPI Number	:	1043565625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMUNDO D FERMIN LMSW, CASAC

Provider Business Mailing Address
First Line	:	1306 COLLEGE AVE APT 1D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-1541
Country	:	US
Telephone Number	:	646-457-1468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 COLLEGE AVE APT 1D
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-1541
Country	:	US
Telephone Number	:	646-457-1468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	01/16/2015

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