Provider Demographics
NPI:1679537922
Name:RAYMOND, LAURIE WATSON (MD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:WATSON
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1180 BEACON ST
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3885
Mailing Address - Country:US
Mailing Address - Phone:617-731-1917
Mailing Address - Fax:617-731-1917
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:SUITE 4C
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-731-1917
Practice Address - Fax:617-731-1917
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA430542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB11691Medicare ID - Type UnspecifiedPSYCHIATRIST
MAB72865Medicare UPIN