Provider Demographics
NPI:1912966235
Name:RALPH, KENNETH M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:RALPH
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 1:1861 WICKERSHAM LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2327
Mailing Address - Country:US
Mailing Address - Phone:717-393-0707
Mailing Address - Fax:717-393-4605
Practice Address - Street 1:1861 WICKERSHAM LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2327
Practice Address - Country:US
Practice Address - Phone:717-393-0707
Practice Address - Fax:717-393-4605
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003183-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA199042Medicare ID - Type UnspecifiedPROVIDER #