Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 35S100121400 | NJ |
N | 103G00000X | Clinical Psychologist | 35S100121400 | NJ |
N | 103TC0700X | Clinical Psychologist | 35S100121400 | NJ |
NPI | 1053527580 |
---|---|
Provider Name | Dr. Raymond Grant Kingsley |
First Address | Salisbury, MD 21801-6214 |
Second Address | Cambridge, MD 21613-9408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 08/07/2007 |