Healthcare Provider Details

I. General information

NPI: 1386889079
Provider Name (Legal Business Name): ROBIN RAIKE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14295 GREEN VALLEY RD
FORESTVILLE CA
95436-9248
US

IV. Provider business mailing address

14295 GREEN VALLEY RD
FORESTVILLE CA
95436-9248
US

V. Phone/Fax

Practice location:
  • Phone: 707-887-1419
  • Fax:
Mailing address:
  • Phone: 707-887-1419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: