Provider Demographics
NPI:1558990770
Name:PATRAITIS, LAURIE JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:JEAN
Last Name:PATRAITIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BRUCE CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3601
Mailing Address - Country:US
Mailing Address - Phone:925-988-8087
Mailing Address - Fax:
Practice Address - Street 1:419 30TH ST STE 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3374
Practice Address - Country:US
Practice Address - Phone:510-444-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical