Provider Demographics
NPI:1114104791
Name:MCNAMARA, RAYMOND JOHN (CCC/SLP)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:JOHN
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-1337
Mailing Address - Country:US
Mailing Address - Phone:716-597-6234
Mailing Address - Fax:
Practice Address - Street 1:2128 ELMWOOD AVE
Practice Address - Street 2:PEOPLE INC
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-1910
Practice Address - Country:US
Practice Address - Phone:716-874-5600
Practice Address - Fax:716-874-0388
Is Sole Proprietor?:No
Enumeration Date:2008-01-26
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009150235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist