Provider Demographics
NPI:1356354245
Name:RAYMOND, ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:RAYMOND
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 1:408 BLOOMFIELD AVE STE A-1
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3573
Mailing Address - Country:US
Mailing Address - Phone:973-744-1774
Mailing Address - Fax:212-787-6985
Practice Address - Street 1:408 BLOOMFIELD AVE STE A-1
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3573
Practice Address - Country:US
Practice Address - Phone:973-744-1774
Practice Address - Fax:212-787-6985
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ597836Medicare ID - Type Unspecified