Provider Demographics
NPI:1114019064
Name:WOOTTON, RAYMOND JOSHUA (PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOSHUA
Last Name:WOOTTON
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1 BROOKLINE PL STE 105
Mailing Address - Street 2:ARNOLD-WARFIELD PAIN CTR, BETH ISRAEL DEACONESS MED CTR
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7294
Mailing Address - Country:US
Mailing Address - Phone:617-278-8000
Mailing Address - Fax:617-278-8065
Practice Address - Street 1:1 BROOKLINE PL STE 105
Practice Address - Street 2:ARNOLD-WARFIELD PAIN CTR, BETH ISRAEL DEACONESS MED CTR
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7294
Practice Address - Country:US
Practice Address - Phone:617-278-8000
Practice Address - Fax:617-278-8065
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical