Provider Demographics
NPI:1679090153
Name:HERBERT, RAYMOND TRAVIS (MSW)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:TRAVIS
Last Name:HERBERT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SENECA CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1386
Mailing Address - Country:US
Mailing Address - Phone:720-432-1353
Mailing Address - Fax:
Practice Address - Street 1:5277 MANHATTAN CIR STE 250
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-8212
Practice Address - Country:US
Practice Address - Phone:720-432-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker