MEDICARE: PETALS CATRECE RAINEY-BOONE MS, ED.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	2318	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134314628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETALS CATRECE RAINEY-BOONE MS, ED.S

Provider Business Mailing Address
First Line	:	1317 UJAMAA DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-5773
Country	:	US
Telephone Number	:	919-755-3396
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 UJAMAA DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-5773
Country	:	US
Telephone Number	:	919-755-3396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2007
Last Update Date	:	10/01/2008

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