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General NPI Number Information
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NPI Number | 1326590027
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Entity Type | Organization
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Legal Business Name | RAE DUMONT, FAMILY CONSULTS LLC
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 103 PARK STREET SUITE 4
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City | MONTCLAIR
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State | NJ
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Zip | 07042
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Country | US
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Telephone | 207-422-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 225
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City | MONTCLAIR
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State | NJ
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Zip | 07042-0225
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Country | US
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Telephone | 207-422-2020
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | RAYMONDE H DUMONT
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Credential |
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Telephone | 207-422-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | NJ
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