Provider Demographics
NPI:1538460936
Name:CARBAUGH, RONALD G (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:CARBAUGH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11684 HURON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2924
Mailing Address - Country:US
Mailing Address - Phone:303-252-7436
Mailing Address - Fax:303-255-9698
Practice Address - Street 1:11684 HURON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2924
Practice Address - Country:US
Practice Address - Phone:303-252-7436
Practice Address - Fax:303-255-9698
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical