Provider Demographics
NPI:1295820397
Name:RAIT, DOUGLAS SAMUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SAMUEL
Last Name:RAIT
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 1:4515 52ND AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:AL
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:650-323-3219
Mailing Address - Fax:
Practice Address - Street 1:900 WELCH RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1805
Practice Address - Country:US
Practice Address - Phone:650-323-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical