Provider Demographics
NPI:1245321298
Name:RONALD D. PEARSE,EDD
Entity type:Organization
Organization Name:RONALD D. PEARSE,EDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEARSE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:304-367-9232
Mailing Address - Street 1:1314 LOCUST AVE.
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-367-0232
Mailing Address - Fax:304-367-0233
Practice Address - Street 1:1314 LOCUST AVE.
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-367-0232
Practice Address - Fax:304-367-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000125Medicaid
WVPECP09251Medicare ID - Type Unspecified