MEDICARE: MRS. NICOLE RAYMO LCSW

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

General Provider Information

NPI Number	:	1912259813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE RAYMO LCSW

Provider Business Mailing Address
First Line	:	13885 HEDGEWOOD DR STE 233
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-7931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13885 HEDGEWOOD DR STE 233
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-7931
Country	:	US
Telephone Number	:	571-285-1403
Fax Number	:

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

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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