Provider Demographics
NPI:1972724508
Name:RAYMOND, PATRICIA M (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
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 1:163 GEORGE ALLEN ROAD
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814
Mailing Address - Country:US
Mailing Address - Phone:401-567-0115
Mailing Address - Fax:
Practice Address - Street 1:2090 WALLUM LAKE ROAD
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859
Practice Address - Country:US
Practice Address - Phone:440-156-7544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00252103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical