Provider Demographics
NPI:1376704338
Name:RAGONESI, AMANDA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:RAGONESI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 NE 3RD AVE # 1005
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2408
Mailing Address - Country:US
Mailing Address - Phone:360-909-2456
Mailing Address - Fax:
Practice Address - Street 1:3252 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2448
Practice Address - Country:US
Practice Address - Phone:360-909-2456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60051107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical