Healthcare Provider Details

I. General information

NPI: 1821082934
Provider Name (Legal Business Name): DONALD RAYMOND MOUNT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: 'RAY' MOUNT, PH.D. PH.D.

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 WATER ST. SUITE 405
WAKEFIELD MA
01880
US

IV. Provider business mailing address

27 WATER ST. SUITE 405
WAKEFIELD MA
01880
US

V. Phone/Fax

Practice location:
  • Phone: 781-246-4570
  • Fax: 781-246-1614
Mailing address:
  • Phone: 781-246-4570
  • Fax: 781-246-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4496
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4496
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: