Healthcare Provider Details

I. General information

NPI: 1083644546
Provider Name (Legal Business Name): RONALD M WESTRATE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380E COUNTY LINE RD
INDIANAPOLIS IN
46227-0962
US

IV. Provider business mailing address

4860 ROBB ST 201
WHEAT RIDGE CO
80033-2162
US

V. Phone/Fax

Practice location:
  • Phone: 317-885-7050
  • Fax:
Mailing address:
  • Phone: 303-278-7418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number35SI00157600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number20042356A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: