Provider Demographics
NPI:1851697973
Name:LITTLEWOOD, RAE A (PHD)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:A
Last Name:LITTLEWOOD
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 1:9426 INDIAN SCHOOL RD NE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2887
Mailing Address - Country:US
Mailing Address - Phone:505-345-6100
Mailing Address - Fax:
Practice Address - Street 1:9426 INDIAN SCHOOL RD NE STE 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2887
Practice Address - Country:US
Practice Address - Phone:505-345-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical