Provider Demographics
NPI:1326590027
Name:RAE DUMONT, FAMILY CONSULTS LLC
Entity Type:Organization
Organization Name:RAE DUMONT, FAMILY CONSULTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMONDE
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-422-2020
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-0225
Mailing Address - Country:US
Mailing Address - Phone:207-422-2020
Mailing Address - Fax:
Practice Address - Street 1:103 PARK STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:207-422-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health