Healthcare Provider Details

I. General information

NPI: 1922678044
Provider Name (Legal Business Name): THOMAS RATEKIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 OLD RIDGEBURY ROAD
DANBURY CT
06810
US

IV. Provider business mailing address

38 OLD RIDGEBURY ROAD
DANBURY CT
06810
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-4515
  • Fax:
Mailing address:
  • Phone: 203-792-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4693
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: