MEDICARE: MR. DAVID RAUGHTON MFT

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	106H00000X	Marriage & Family Therapist	MFC21076	CA

General Provider Information

NPI Number	:	1982800090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID RAUGHTON MFT

Provider Business Mailing Address
First Line	:	2576 SHATTUCK AVE # 7
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-2724
Country	:	US
Telephone Number	:	510-206-9015
Fax Number	:

Provider Business Practice Location Address
First Line	:	2576 SHATTUCK AVE # 7
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-2724
Country	:	US
Telephone Number	:	510-206-9015
Fax Number	:

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	07/08/2007

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