Provider Demographics
NPI:1033600606
Name:RACITI, MICHAEL ALFRED (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALFRED
Last Name:RACITI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WINGATE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4721
Mailing Address - Country:US
Mailing Address - Phone:401-722-5256
Mailing Address - Fax:
Practice Address - Street 1:12 WINGATE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4721
Practice Address - Country:US
Practice Address - Phone:401-722-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4263-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical