Provider Demographics
NPI:1972659944
Name:REDELMAN, RAYMOND J (MA LFMT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:REDELMAN
Suffix:
Gender:M
Credentials:MA LFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E WILLOW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-9998
Mailing Address - Country:US
Mailing Address - Phone:630-665-4141
Mailing Address - Fax:
Practice Address - Street 1:200 E WILLOW
Practice Address - Street 2:SUITE 101
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-9998
Practice Address - Country:US
Practice Address - Phone:630-665-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist