Provider Demographics
NPI:1962670596
Name:SKURDA, RAYMOND CARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CARL
Last Name:SKURDA
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 1:233 SOUTHBOUND GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2413
Mailing Address - Country:US
Mailing Address - Phone:586-465-9082
Mailing Address - Fax:586-464-7900
Practice Address - Street 1:233 SOUTHBOUND GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2413
Practice Address - Country:US
Practice Address - Phone:586-465-9082
Practice Address - Fax:586-464-7900
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OEO4518Medicare PIN