Provider Demographics
NPI:1053456467
Name:LIGHTSTONE, RAYMOND PAUL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:PAUL
Last Name:LIGHTSTONE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HEMPSTEAD AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1614
Mailing Address - Country:US
Mailing Address - Phone:516-596-9150
Mailing Address - Fax:
Practice Address - Street 1:50 HEMPSTEAD AVE
Practice Address - Street 2:SUITE I
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1614
Practice Address - Country:US
Practice Address - Phone:516-596-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011169103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV5B752Medicare ID - Type Unspecified