Provider Demographics
NPI:1437382199
Name:DR. DANA RATSPRECHER PSY.D., LLC
Entity Type:Organization
Organization Name:DR. DANA RATSPRECHER PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-629-0435
Mailing Address - Street 1:6658 MONTEGO BAY BLVD APT F
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4060
Mailing Address - Country:US
Mailing Address - Phone:954-629-0435
Mailing Address - Fax:
Practice Address - Street 1:6658 MONTEGO BAY BLVD APT F
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-4060
Practice Address - Country:US
Practice Address - Phone:954-629-0435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA606359339Medicaid