Provider Demographics
NPI:1881933398
Name:IVERSON, RONALD LLOYD (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LLOYD
Last Name:IVERSON
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 1:2565 PUESTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2936
Mailing Address - Country:US
Mailing Address - Phone:805-698-1653
Mailing Address - Fax:805-845-6296
Practice Address - Street 1:2565 PUESTA DEL SOL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-2936
Practice Address - Country:US
Practice Address - Phone:805-698-1653
Practice Address - Fax:805-845-6296
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical