Basic Information
Provider Information
NPI: 1730248618
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAGUSEA
FirstName: ANTHONY
MiddleName: STEPHEN
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 HOSPITAL DR STE 306
Address2:  
City: LEWISBURG
State: PA
PostalCode: 178379350
CountryCode: US
TelephoneNumber: 5705224110
FaxNumber: 5707683911
Practice Location
Address1: 3 HOSPITAL DR STE 204
Address2:  
City: LEWISBURG
State: PA
PostalCode: 178379394
CountryCode: US
TelephoneNumber: 5705246766
FaxNumber: 5705246841
Other Information
ProviderEnumerationDate: 12/07/2006
LastUpdateDate: 06/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPS016860PAY Behavioral Health & Social Service ProvidersPsychologistClinical
103TC0700XPY7436FLN Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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