Provider Demographics
NPI:1922596881
Name:RITROVATO, SUSAN LORAIN (HHAP,PMA)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LORAIN
Last Name:RITROVATO
Suffix:
Gender:F
Credentials:HHAP,PMA
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:LORAIN
Other - Last Name:RITROVATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMA,PSY,D
Mailing Address - Street 1:2518 BURNSED BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2704
Mailing Address - Country:US
Mailing Address - Phone:267-673-3630
Mailing Address - Fax:
Practice Address - Street 1:2518 BURNSED BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2704
Practice Address - Country:US
Practice Address - Phone:267-673-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31702939101YP1600X, 103T00000X
31702939103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31702939OtherALL PROVIDERS MEDICARE
FL00317736OtherMEDICARE/ALL INSURANCES