Provider Demographics
NPI:1073684544
Name:TRAVAGLIONE, RONALD PAUL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:TRAVAGLIONE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02768-0487
Mailing Address - Country:US
Mailing Address - Phone:508-369-5711
Mailing Address - Fax:508-584-3480
Practice Address - Street 1:209 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2926
Practice Address - Country:US
Practice Address - Phone:508-584-2291
Practice Address - Fax:508-584-3480
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY62201Medicare ID - Type UnspecifiedMEDICARE