Provider Demographics
NPI:1346323151
Name:CHANDLER, RAYMOND A (MED)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WYMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473
Mailing Address - Country:US
Mailing Address - Phone:978-807-6823
Mailing Address - Fax:
Practice Address - Street 1:16 WYMAN ROAD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473
Practice Address - Country:US
Practice Address - Phone:978-807-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1556101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0940OtherBLUE CROSS BLUE SHIELD
MA486025OtherTUFTS HLTH PLAN