Healthcare Provider Details

I. General information

NPI: 1689647323
Provider Name (Legal Business Name): ERIC RANKIN PH.D., LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 CHESTNUT RIDGE RD
MORGANTOWN WV
26505-2807
US

IV. Provider business mailing address

PO BOX 897
MORGANTOWN WV
26507-0897
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4214
  • Fax: 304-293-6963
Mailing address:
  • Phone: 304-293-7401
  • Fax: 304-293-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00080149
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: