Provider Demographics
NPI:1154349165
Name:RAYMOND, ANTHONY MICHAEL (MS LLP CAAC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:RAYMOND
Suffix:
Gender:M
Credentials:MS LLP CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-4316
Mailing Address - Country:US
Mailing Address - Phone:248-470-2534
Mailing Address - Fax:
Practice Address - Street 1:4950 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1142
Practice Address - Country:US
Practice Address - Phone:248-674-3382
Practice Address - Fax:248-674-0083
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical