Provider Demographics
NPI:1376584607
Name:ZITO, RAYMOND CHRISTOPHER (LCSW)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CHRISTOPHER
Last Name:ZITO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 COMMERCIAL ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4679
Mailing Address - Country:US
Mailing Address - Phone:207-773-6777
Mailing Address - Fax:207-773-0550
Practice Address - Street 1:217 COMMERCIAL ST
Practice Address - Street 2:SUITE 302
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4679
Practice Address - Country:US
Practice Address - Phone:207-773-6777
Practice Address - Fax:207-773-0550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC70031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2186000990Medicaid
MEMM7995Medicare ID - Type Unspecified