Healthcare Provider Details

I. General information

NPI: 1861623977
Provider Name (Legal Business Name): ELIZABETH M. RAYMOND M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 STOKES RD SUITE B6
MEDFORD NJ
08055-2904
US

IV. Provider business mailing address

520 STOKES RD SUITE B6
MEDFORD NJ
08055-2904
US

V. Phone/Fax

Practice location:
  • Phone: 609-654-5340
  • Fax: 609-654-5342
Mailing address:
  • Phone: 609-654-5340
  • Fax: 609-654-5342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5423
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: