Provider Demographics
NPI:1922476704
Name:RATNER-FITZGERALD, CAROLYN JOYCE (PSYD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOYCE
Last Name:RATNER-FITZGERALD
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 1:635 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4109
Mailing Address - Country:US
Mailing Address - Phone:703-996-9131
Mailing Address - Fax:
Practice Address - Street 1:635 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4109
Practice Address - Country:US
Practice Address - Phone:703-996-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004897103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
47-1033331OtherEIN