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NPI Code Detail

MEDICARE: TERRY JOSEPH RAIMOND LPCC-S, CDCA

MEDICARE: TERRY JOSEPH RAIMOND LPCC-S, CDCA
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.163919OH
2101YP2500XProfessional CounselorE.1700459-SUPVOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568868156
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY JOSEPH RAIMOND LPCC-S, CDCA
Provider Business Mailing Address
First Line : 5209 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-2224
Country : US
Telephone Number : 216-325-9325
Fax Number :
Provider Business Practice Location Address
First Line : 5209 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-2224
Country : US
Telephone Number : 216-325-9325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2014
Last Update Date : 08/01/2024

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