Provider Demographics
NPI:1427583863
Name:RAGONESE, SARAH M (PHD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:M
Last Name:RAGONESE
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 W STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-8010
Mailing Address - Country:US
Mailing Address - Phone:812-272-3398
Mailing Address - Fax:
Practice Address - Street 1:5414 W STONEWOOD DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-8010
Practice Address - Country:US
Practice Address - Phone:812-272-3398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042855A103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent