Provider Demographics
NPI:1124777149
Name:LANDRY, RAYMOND (LMHC, LADC1)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:LANDRY
Suffix:
Gender:M
Credentials:LMHC, LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-0317
Mailing Address - Country:US
Mailing Address - Phone:413-362-9855
Mailing Address - Fax:
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3317
Practice Address - Country:US
Practice Address - Phone:413-734-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20981101YA0400X
MALMHC10003509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)