Provider Demographics
NPI:1477571511
Name:RATCLIFF, BRENDA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:JEAN
Last Name:RATCLIFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:RATCLIFF
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5770 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NATURAL BRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24578-4039
Mailing Address - Country:US
Mailing Address - Phone:540-529-1124
Mailing Address - Fax:540-291-8339
Practice Address - Street 1:5770 PLANK RD
Practice Address - Street 2:
Practice Address - City:NATURAL BRIDGE
Practice Address - State:VA
Practice Address - Zip Code:24578-4039
Practice Address - Country:US
Practice Address - Phone:540-529-1124
Practice Address - Fax:540-291-8339
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0811000003103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010001897Medicaid
VA11-3701532OtherVIRGINIA HEALTH NETWORK
VA11-3701532OtherTRICARE-CHAMPUS
VA142607OtherANTHEM BCBS
VA9528762OtherCIGNA