Provider Demographics
NPI:1982755062
Name:RAO, ARATHI R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARATHI
Middle Name:R
Last Name:RAO
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 1:688 KNOWLES AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4102
Mailing Address - Country:US
Mailing Address - Phone:215-364-3722
Mailing Address - Fax:215-968-9034
Practice Address - Street 1:688 KNOWLES AVE
Practice Address - Street 2:UNIT C
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4102
Practice Address - Country:US
Practice Address - Phone:215-364-3722
Practice Address - Fax:215-968-9034
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005604L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0058816000OtherBLUE CROSS
PA599780Medicare ID - Type UnspecifiedMEDICARE
PA0058816000OtherBLUE CROSS