Provider Demographics
NPI:1821082934
Name:MOUNT, DONALD RAYMOND (PHD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAYMOND
Last Name:MOUNT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:'RAY'
Other - Middle Name:
Other - Last Name:MOUNT, PH.D.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:27 WATER ST.
Mailing Address - Street 2:SUITE 405
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:781-246-4570
Mailing Address - Fax:781-246-1614
Practice Address - Street 1:27 WATER ST.
Practice Address - Street 2:SUITE 405
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-246-4570
Practice Address - Fax:781-246-1614
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4496103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4496OtherPSYCHOLOGIST LICENSE
MA4496OtherPSYCHOLOGIST LICENSE