Provider Demographics
NPI:1699065391
Name:RAE A. LITTLEWOOD, PHD, LLC
Entity type:Organization
Organization Name:RAE A. LITTLEWOOD, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-977-7972
Mailing Address - Street 1:9426 INDIAN SCHOOL RD NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2886
Mailing Address - Country:US
Mailing Address - Phone:505-345-6100
Mailing Address - Fax:505-345-4531
Practice Address - Street 1:9426 INDIAN SCHOOL RD NE
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2886
Practice Address - Country:US
Practice Address - Phone:505-345-6100
Practice Address - Fax:505-345-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1167103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty