Provider Demographics
NPI:1326434598
Name:DAVID RAINEN, PSYD LLC
Entity Type:Organization
Organization Name:DAVID RAINEN, PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-502-5398
Mailing Address - Street 1:10 ESSEX ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 ESSEX ST
Practice Address - Street 2:SUITE 8
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3729
Practice Address - Country:US
Practice Address - Phone:978-282-7063
Practice Address - Fax:978-975-4149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10095103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty