Provider Demographics
NPI:1891759460
Name:RONKIN, ALAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:RONKIN
Suffix:
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 1:855 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1133
Mailing Address - Country:US
Mailing Address - Phone:508-230-8366
Mailing Address - Fax:
Practice Address - Street 1:855 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1133
Practice Address - Country:US
Practice Address - Phone:508-230-8366
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA69042354OtherUNITED BEHAVIORAL HEALTH