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General NPI Number Information
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NPI Number | 1609147479
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Entity Type | Organization
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Legal Business Name | MICHAEL H. RATHJENS, PSY.D, PA
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 12012 S SHORE BLVD STE 108
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City | WELLINGTON
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State | FL
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Zip | 33414-6203
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Country | US
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Telephone | 561-790-7975
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Fax | 561-790-4788
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Provider Business Mailing Address
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Address Line | 4682 FOXVIEW PL
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City | LAKE WORTH
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State | FL
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Zip | 33467-3510
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Country | US
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Telephone | 561-790-7975
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Fax | 561-790-4788
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL H RATHJENS
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Credential | PSY.D
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Telephone | 561-790-7975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY4666
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License Number State | FL
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