MEDICARE: RAYMOND HAVERCOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1598112088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND HAVERCOME

Provider Business Mailing Address
First Line	:	735 E 46TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5731
Country	:	US
Telephone Number	:	706-289-6748
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 E 46TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5731
Country	:	US
Telephone Number	:	706-289-6748
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	05/16/2016

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Directions to “ RAYMOND HAVERCOME ” Practice Location

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