Provider Demographics
NPI:1760688782
Name:BARONE, RAYMOND B (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:B
Last Name:BARONE
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 1:3200 FISHBACK RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-6307
Mailing Address - Country:US
Mailing Address - Phone:618-529-4881
Mailing Address - Fax:618-351-1419
Practice Address - Street 1:3200 FISHBACK RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-6307
Practice Address - Country:US
Practice Address - Phone:618-529-4881
Practice Address - Fax:618-351-1419
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health