Provider Demographics
NPI:1770457053
Name:RAIA, MARY ALICE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:RAIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3087 LIVORNO CIR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6815
Mailing Address - Country:US
Mailing Address - Phone:805-400-9696
Mailing Address - Fax:
Practice Address - Street 1:3220 S HIGUERA ST STE 231-B
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6987
Practice Address - Country:US
Practice Address - Phone:820-777-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist