Provider Demographics
NPI:1669671905
Name:RAYMOND, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 SUTTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02746-1232
Mailing Address - Country:US
Mailing Address - Phone:508-993-4061
Mailing Address - Fax:
Practice Address - Street 1:100 N FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7350
Practice Address - Country:US
Practice Address - Phone:508-994-0885
Practice Address - Fax:508-997-0765
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1311603Medicaid