Provider Demographics
NPI:1053771568
Name:RAYMOND, MARISA (MS MPH CGC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MS MPH CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHEMIN DE TIRECUL
Mailing Address - Street 2:
Mailing Address - City:FLOIRAC
Mailing Address - State:GIRONDE
Mailing Address - Zip Code:33270
Mailing Address - Country:FR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:872 RACQUET LN
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2935
Practice Address - Country:US
Practice Address - Phone:917-477-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS