Provider Demographics
NPI:1730547415
Name:RAYMOND F. ANGELINI, PH.D. PSYCHOLOGIST P.C.
Entity type:Organization
Organization Name:RAYMOND F. ANGELINI, PH.D. PSYCHOLOGIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANGELINI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-583-2679
Mailing Address - Street 1:648 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5607
Mailing Address - Country:US
Mailing Address - Phone:518-583-2679
Mailing Address - Fax:518-583-1913
Practice Address - Street 1:648 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5607
Practice Address - Country:US
Practice Address - Phone:518-583-2679
Practice Address - Fax:518-583-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009289103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52504BOtherMEDICARE PTAN