Provider Demographics
NPI:1982725073
Name:LAINE, RICHARD A (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:LAINE
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 1:52 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1657
Mailing Address - Country:US
Mailing Address - Phone:508-295-5104
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:STE C4
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2152
Practice Address - Country:US
Practice Address - Phone:508-295-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical