Provider Demographics
NPI:1780035931
Name:HARTMAN, RAYNA
Entity type:Individual
Prefix:
First Name:RAYNA
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:RAYNA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8800 SIERRA COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6414
Mailing Address - Country:US
Mailing Address - Phone:408-859-2537
Mailing Address - Fax:
Practice Address - Street 1:8800 SIERRA COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6414
Practice Address - Country:US
Practice Address - Phone:916-905-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15353101YP2500X
CA134817106H00000X
171M00000X, 390200000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program