Provider Demographics
NPI:1952489981
Name:RAGSDALE, BRIAN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:RAGSDALE
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 1:265 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03444-8207
Mailing Address - Country:US
Mailing Address - Phone:773-420-9474
Mailing Address - Fax:
Practice Address - Street 1:265 BOULDER DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:NH
Practice Address - Zip Code:03444-8207
Practice Address - Country:US
Practice Address - Phone:773-420-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71007146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical