Provider Demographics
NPI:1861623977
Name:RAYMOND, ELIZABETH M (MS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 STOKES RD
Mailing Address - Street 2:SUITE B6
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2904
Mailing Address - Country:US
Mailing Address - Phone:609-654-5340
Mailing Address - Fax:609-654-5342
Practice Address - Street 1:520 STOKES RD
Practice Address - Street 2:SUITE B6
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2904
Practice Address - Country:US
Practice Address - Phone:609-654-5340
Practice Address - Fax:609-654-5342
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NJ5423103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst