Provider Demographics
NPI:1992818439
Name:DEER CREEK PSYCHOLOGICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:DEER CREEK PSYCHOLOGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-643-9252
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:EAST THETFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05043-0266
Mailing Address - Country:US
Mailing Address - Phone:802-785-2903
Mailing Address - Fax:802-785-2631
Practice Address - Street 1:45 LYME RD
Practice Address - Street 2:SUITE 202A
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1219
Practice Address - Country:US
Practice Address - Phone:802-785-2543
Practice Address - Fax:802-785-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT062-19470OtherVT BLUECROSS BLUESHIELD
NH50Y303300VT01OtherANTHEM BCBS
NHRE2997Medicare PIN
NH50Y303300VT01OtherANTHEM BCBS