Provider Demographics
NPI:1104064880
Name:RAYMOND, CARA CHRISTINA (PHD)
Entity type:Individual
Prefix:DR
First Name:CARA
Middle Name:CHRISTINA
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3392
Mailing Address - Country:US
Mailing Address - Phone:847-321-5731
Mailing Address - Fax:
Practice Address - Street 1:1035 W GLEN OAKS LN
Practice Address - Street 2:SUITE 204
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3392
Practice Address - Country:US
Practice Address - Phone:847-321-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007598103TC0700X
WI2913-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical