Provider Demographics
NPI:1891758306
Name:REFICE, RONALD III (PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:REFICE
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 BOULEVARD AVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1710
Mailing Address - Country:US
Mailing Address - Phone:570-383-2799
Mailing Address - Fax:570-383-0063
Practice Address - Street 1:650 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1710
Practice Address - Country:US
Practice Address - Phone:570-383-2799
Practice Address - Fax:570-383-0063
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001198L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA029768OtherBLUE SHIELD
PA804930OtherFIRST PRIORITY
PA029768OtherBLUE SHIELD