Provider Demographics
NPI:1255485694
Name:RABOLD, DENISE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ELIZABETH
Last Name:RABOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E CAMPUS VIEW BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235
Mailing Address - Country:US
Mailing Address - Phone:614-847-9008
Mailing Address - Fax:614-847-9045
Practice Address - Street 1:1 E CAMPUS VIEW BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235
Practice Address - Country:US
Practice Address - Phone:614-847-9008
Practice Address - Fax:614-847-9045
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5350103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2065198Medicaid
OH293973000OtherMIS NUMBER
OH293973000OtherMIS NUMBER
S53090Medicare UPIN