Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3719 | AZ |
N | 103T00000X | Psychologist | 3719 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3719 | AZ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3719 | AZ |
N | 103G00000X | Clinical Psychologist | 3719 | AZ |
N | 103TC0700X | Clinical Psychologist | 3719 | AZ |
N | 103TC1900X | Counseling Psychologist | 3719 | AZ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3719 | AZ |
N | 103TF0000X | Family Psychologist | 3719 | AZ |
NPI | 1588745897 |
---|---|
Provider Name | Dr. Raymond Edward Branton |
First Address | Tempe, AZ 85283-3241 |
Second Address | Mesa, AZ 85210-3056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |