Healthcare Provider Details

I. General information

NPI: 1326590027
Provider Name (Legal Business Name): RAE DUMONT, FAMILY CONSULTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PARK STREET SUITE 4
MONTCLAIR NJ
07042
US

IV. Provider business mailing address

PO BOX 225
MONTCLAIR NJ
07042-0225
US

V. Phone/Fax

Practice location:
  • Phone: 207-422-2020
  • Fax:
Mailing address:
  • Phone: 207-422-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: RAYMONDE H DUMONT
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 207-422-2020