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General NPI Number Information
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NPI Number | 1558990770
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Entity Type | Individual
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Provider Name | LAURIE JEAN PATRAITIS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 419 30TH ST STE 3
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City | OAKLAND
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State | CA
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Zip | 94609-3374
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Country | US
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Telephone | 510-444-4810
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Fax |
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Provider Business Mailing Address
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Address Line | 41 BRUCE CT
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City | PLEASANT HILL
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State | CA
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Zip | 94523-3601
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Country | US
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Telephone | 925-988-8087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY15055
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License Number State | CA
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