Provider Demographics
NPI:1053527580
Name:KINGSLEY, RAYMOND GRANT (PHD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:GRANT
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MIDDLE BLVD.
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-6214
Mailing Address - Country:US
Mailing Address - Phone:410-251-8735
Mailing Address - Fax:410-548-3227
Practice Address - Street 1:830 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-9408
Practice Address - Country:US
Practice Address - Phone:410-228-6305
Practice Address - Fax:410-392-6381
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100121400103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical