Provider Demographics
NPI:1386371631
Name:BARRETT, RAYMOND
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAYMOND
Other - Middle Name:
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:91 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3876
Mailing Address - Country:US
Mailing Address - Phone:516-458-7617
Mailing Address - Fax:
Practice Address - Street 1:47 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2881
Practice Address - Country:US
Practice Address - Phone:516-458-7617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020769-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist