Provider Demographics
NPI:1417060963
Name:CHIN, RAYMOND J (PHD, MFA)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:CHIN
Suffix:
Gender:M
Credentials:PHD, MFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:EAST THETFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05043-0176
Mailing Address - Country:US
Mailing Address - Phone:603-643-9252
Mailing Address - Fax:888-972-3709
Practice Address - Street 1:43 LEBANON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2513
Practice Address - Country:US
Practice Address - Phone:603-643-9252
Practice Address - Fax:888-972-3709
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical