Provider Demographics
NPI:1811194780
Name:RATLIFFE, CONSTANCE ANN (DR)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:ANN
Last Name:RATLIFFE
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 LITCHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1228
Mailing Address - Country:US
Mailing Address - Phone:805-259-8949
Mailing Address - Fax:
Practice Address - Street 1:1187 COAST VILLAGE RD
Practice Address - Street 2:SUITE 10-J
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2737
Practice Address - Country:US
Practice Address - Phone:805-259-8949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20369103TC0700X
MI6301010435103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0892445Medicare ID - Type Unspecified