Provider Demographics
NPI:1740492750
Name:SAMPAIO, RITA CASSIA (PHD)
Entity type:Individual
Prefix:DR
First Name:RITA
Middle Name:CASSIA
Last Name:SAMPAIO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:SAMPAEO-SHAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 LUCILLE WAY
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3705
Mailing Address - Country:US
Mailing Address - Phone:925-295-4145
Mailing Address - Fax:925-925-5226
Practice Address - Street 1:108 LUCILLE WAY
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3705
Practice Address - Country:US
Practice Address - Phone:925-295-4145
Practice Address - Fax:925-925-5226
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18107103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
5877365OtherKAISER MEDICAL RECORD NUMBER
NITEROIMedicare PIN