Provider Demographics
NPI:1982915872
Name:LAITINEN, RICHARD EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDWARD
Last Name:LAITINEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 TOWNSEND DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5025
Mailing Address - Country:US
Mailing Address - Phone:831-600-6217
Mailing Address - Fax:831-689-9904
Practice Address - Street 1:421 TOWNSEND DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-5025
Practice Address - Country:US
Practice Address - Phone:831-600-6217
Practice Address - Fax:650-938-3601
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1646103K00000X
CA1-09-6506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst