Healthcare Provider Details

I. General information

NPI: 1407832702
Provider Name (Legal Business Name): RAYMOND EDWARD ARSENAULT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAIN ST
NORTH ANDOVER MA
01845-2410
US

IV. Provider business mailing address

10 MAIN ST
NORTH ANDOVER MA
01845-2410
US

V. Phone/Fax

Practice location:
  • Phone: 978-985-4083
  • Fax: 978-372-7563
Mailing address:
  • Phone: 978-985-4083
  • Fax: 978-372-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2842
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: