Provider Demographics
NPI:1679591317
Name:MANCINI, RONDA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RONDA
Middle Name:L
Last Name:MANCINI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 SPRINGHURST BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6137
Mailing Address - Country:US
Mailing Address - Phone:502-394-0101
Mailing Address - Fax:502-425-4275
Practice Address - Street 1:3801 SPRINGHURST BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6137
Practice Address - Country:US
Practice Address - Phone:502-394-0101
Practice Address - Fax:502-425-4275
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1228103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q019206Medicare UPIN
KY0719206Medicare ID - Type Unspecified