Active NPI
Lawrence J. Raifman, PH.D., J. D.
- Clinical Psychologist
- Baltimore, MD
National Provider Identifier
1114139557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1757
- Practice address
- 1501 Sulgrave Ave
Suite 208
Baltimore, MD 21209-3654 - Phone
- (410) 998-9245
- Fax
- (410) 998-9250
- NPI assigned
- May 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1757 | MD | Primary |
Addresses
Primary practice location
1501 Sulgrave Ave
Suite 208
Baltimore, MD 21209-3654
Mailing address
11005 Valley Heights Dr
Owings Mills, MD 21117-3056
Phone (410) 998-9245
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Juris Doctor, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1757 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114139557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11005 VALLEY HEIGHTS DR",
"city": "OWINGS MILLS",
"state": "MD",
"postal_code": "211173056",
"telephone_number": "410-998-9245",
"fax_number": "410-998-9250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 SULGRAVE AVE",
"address_2": "SUITE 208",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212093654",
"telephone_number": "410-998-9245",
"fax_number": "410-998-9250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAIFMAN",
"first_name": "LAWRENCE",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PH.D., J. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "1757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.