Rae Sidereal De Lune, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY.0005082 Issued in CO

Practice address

1209 Pearl St Ste 11
Boulder, CO 80302-5221

Phone

(720) 515-5317

NPI assigned

Jul 16, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Daniel Raedel Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1396353231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 PEARL ST STE 11",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803025221",
            "telephone_number": "720-515-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 PEARL ST STE 11",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803025221",
            "telephone_number": "720-515-5317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LUNE",
        "first_name": "RAE",
        "middle_name": "SIDEREAL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-16",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY.0005082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIEL",
            "last_name": "RAEDEL",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sharon Day
• Dcbpt LLC
• Santiago De la Garza, M.D.
• Emmanuel Rellosa De la Paz II, D.D.S.
• Haydee Alexis De Los Santos
• Monica De Valenzuela
• Carolyn Dean
• Janet Dean, MSW
• John Michael Dean, MA CCC-SLP
• Jonathon Leigh Dean

• Psychologist in Boulder, CO
• Providers in Boulder, CO by specialty
• Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.