Provider Demographics
NPI:1679522353
Name:DALTON, RAYMOND (PHD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:DALTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JEFFERSON BARRACKS DR
Mailing Address - Street 2:ST LOUIS VA MEDICAL CENTER
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-4181
Mailing Address - Country:US
Mailing Address - Phone:314-487-0400
Mailing Address - Fax:314-845-5019
Practice Address - Street 1:1 JEFFERSON BARRACKS DR
Practice Address - Street 2:ST LOUIS VA MEDICAL CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-487-0400
Practice Address - Fax:314-845-5019
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0156103TH0100X
IN20010413A103TH0100X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical