Individual
DR. RAE SIDEREAL DE LUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1209 PEARL ST STE 11, BOULDER, CO 80302-5221
(720) 515-5317
Mailing address
1209 PEARL ST STE 11, BOULDER, CO 80302-5221
(720) 515-5317
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY.0005082
CO
Other
Enumeration date
07/16/2020
Last updated
11/02/2022
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