Healthcare Provider Details

I. General information

NPI: 1528084159
Provider Name (Legal Business Name): RITA MADRAZO-PETERSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 W NC HIGHWAY 54 SUITE 505
DURHAM NC
27707-5571
US

IV. Provider business mailing address

908 BAYBERRY DR
CHAPEL HILL NC
27517-8394
US

V. Phone/Fax

Practice location:
  • Phone: 919-932-1680
  • Fax: 919-960-5126
Mailing address:
  • Phone: 919-932-1680
  • Fax: 919-960-5126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2953
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: