# MARYBETH RAYNES L.C.S.W., PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568771061
- **Authorized official:** CAROL WHITE (BUSINESS MANAGER)
- **Authorized official phone:** (801) 531-7389

## Contact information

- **Practice address:** 275 E SOUTH TEMPLE STE 101, SALT LAKE CITY, UT 84111-1243
- **Practice address phone:** (801) 531-7389
- **Practice address fax:** (801) 364-1433
- **Mailing address:** 275 E SOUTH TEMPLE STE 101, SALT LAKE CITY, UT 84111-1243
- **Mailing address phone:** (801) 531-7389
- **Mailing address fax:** (801) 364-1433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 22124871-3501 | UT | Yes |

## Other

- **Enumeration date:** 09/30/2010
- **Last updated:** 09/30/2010