Healthcare Provider Details

I. General information

NPI: 1851697973
Provider Name (Legal Business Name): RAE A LITTLEWOOD PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 ACADEMY RD NE STE 345
ALBUQUERQUE NM
87111-7351
US

IV. Provider business mailing address

10400 ACADEMY RD NE STE 345
ALBUQUERQUE NM
87111-7351
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-6100
  • Fax: 505-212-0042
Mailing address:
  • Phone: 505-345-6100
  • Fax: 505-212-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1167
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: