Provider Demographics
NPI:1437872199
Name:RAYMOND, DAPHNEY BETTY
Entity Type:Individual
Prefix:
First Name:DAPHNEY
Middle Name:BETTY
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 GRUMMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1749
Mailing Address - Country:US
Mailing Address - Phone:973-849-7416
Mailing Address - Fax:
Practice Address - Street 1:187 GRUMMAN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-1749
Practice Address - Country:US
Practice Address - Phone:973-849-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty