Provider Demographics
NPI:1588782270
Name:HIPOLITO, RAEDEL CHRISTIE
Entity type:Individual
Prefix:MISS
First Name:RAEDEL
Middle Name:CHRISTIE
Last Name:HIPOLITO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RAE
Other - Middle Name:
Other - Last Name:HIPOLITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:2309 PACIFIC COAST HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2751
Mailing Address - Country:US
Mailing Address - Phone:310-614-9617
Mailing Address - Fax:424-247-9195
Practice Address - Street 1:2309 PACIFIC COAST HWY
Practice Address - Street 2:STE 102
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2751
Practice Address - Country:US
Practice Address - Phone:310-614-9617
Practice Address - Fax:424-247-9195
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42497106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist