Provider Demographics
NPI:1194966093
Name:RACITI, SONJA LOUISE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SONJA
Middle Name:LOUISE
Last Name:RACITI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 E BUTHERUS DR
Mailing Address - Street 2:STE 5
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2523
Mailing Address - Country:US
Mailing Address - Phone:210-355-6207
Mailing Address - Fax:480-383-6825
Practice Address - Street 1:8160 E BUTHERUS DR
Practice Address - Street 2:STE 5
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2523
Practice Address - Country:US
Practice Address - Phone:210-355-6207
Practice Address - Fax:480-383-6825
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1089103TC0700X
103TC2200X
AZ4696103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN