MEDICARE: DR. SONJA LOUISE RACITI PSY.D.

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	103TC0700X	Clinical Psychologist	1089	HI
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	103TC0700X	Clinical Psychologist	4696	AZ

General Provider Information

NPI Number	:	1194966093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONJA LOUISE RACITI PSY.D.

Provider Business Mailing Address
First Line	:	8160 E BUTHERUS DR
Second Line	:	STE 5
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2523
Country	:	US
Telephone Number	:	210-355-6207
Fax Number	:	480-383-6825

Provider Business Practice Location Address
First Line	:	8160 E BUTHERUS DR
Second Line	:	STE 5
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2523
Country	:	US
Telephone Number	:	210-355-6207
Fax Number	:	480-383-6825

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

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	11/10/2021

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