Provider Demographics
NPI:1457576449
Name:VANFLEET, RISE JAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RISE
Middle Name:JAYNE
Last Name:VANFLEET
Suffix:
Gender:F
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:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17007-0613
Mailing Address - Country:US
Mailing Address - Phone:717-645-1638
Mailing Address - Fax:717-249-9479
Practice Address - Street 1:391 MOUNTAIN ROAD (FAMILY ENHANCEMENT)
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9522
Practice Address - Country:US
Practice Address - Phone:717-645-1638
Practice Address - Fax:717-249-9479
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004870L103T00000X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA700870OtherBLUE SHIELD PROVIDER NUMB