MEDICARE: MARIA C RACITI PH.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	0810001881	VA

General Provider Information

NPI Number	:	1922033414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA C RACITI PH.D.

Provider Business Mailing Address
First Line	:	4102 GEORGE WASHINGTON MEM HWY
Second Line	:	SUITE 102
City	:	YORKTOWN
State	:	VA
Zip	:	23692-2725
Country	:	US
Telephone Number	:	757-877-0150
Fax Number	:	757-877-0151

Provider Business Practice Location Address
First Line	:	4102 GEORGE WASHINGTON MEM HWY
Second Line	:	SUITE 102
City	:	YORKTOWN
State	:	VA
Zip	:	23692-2725
Country	:	US
Telephone Number	:	757-877-0150
Fax Number	:	757-877-0151

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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