Provider Demographics
NPI:1598866600
Name:RATTLIFF, LINDA ELIZABETH (MS,RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ELIZABETH
Last Name:RATTLIFF
Suffix:
Gender:F
Credentials:MS,RN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ELIZABETH
Other - Last Name:ALLEN RATTLIFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,RN
Mailing Address - Street 1:416 LARCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2019
Mailing Address - Country:US
Mailing Address - Phone:610-352-9933
Mailing Address - Fax:610-352-8255
Practice Address - Street 1:11 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3201
Practice Address - Country:US
Practice Address - Phone:610-617-1747
Practice Address - Fax:610-352-8255
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN307313L106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177115000OtherMAGELLAN BEHAVIORAL HEALT
PARA602943OtherPREMIER BLUE SHIELD
PA7266406OtherAETNA BEHAVIORAL HEALTH
PA005934Medicare ID - Type Unspecified