Individual
MR. BRIAN RAYMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
10022 W DYLAN CT, STAR, ID 83669-5643
(208) 571-2723
(208) 348-5573
Mailing address
10022 W DYLAN CT, STAR, ID 83669-5643
(208) 571-2723
(208) 348-5573
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 32132
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002920900
—
ID
01
—
12403159
CAQH
ID
Enumeration date
09/04/2008
Last updated
08/21/2016
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