Provider Demographics
NPI:1912525189
Name:RAGONA, RENEE ANGELA
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANGELA
Last Name:RAGONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31205 WELLSTON DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-7642
Mailing Address - Country:US
Mailing Address - Phone:586-219-1882
Mailing Address - Fax:
Practice Address - Street 1:33493 W 14 MILE RD STE 130
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1587
Practice Address - Country:US
Practice Address - Phone:248-851-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361005022103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist