Provider Demographics
NPI:1780102343
Name:TAINAN, RAYMOND (MA)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:TAINAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:
Other - Last Name:TAINAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:4 NESHAMINY INTERPLEX DRIVE, SUITE 202,
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19052
Mailing Address - Country:US
Mailing Address - Phone:215-322-8860
Mailing Address - Fax:215-322-8867
Practice Address - Street 1:4 NESHAMINY INTERPLEX DRIVE, SUITE 202,
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19052
Practice Address - Country:US
Practice Address - Phone:215-322-8860
Practice Address - Fax:215-322-8867
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001920103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst