MEDICARE: CONSTANCE ANN RATLIFFE DR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY20369	CA
2	103TC0700X	Clinical Psychologist	6301010435	MI

General Provider Information

NPI Number	:	1811194780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE ANN RATLIFFE DR

Provider Business Mailing Address
First Line	:	618 LITCHFIELD LN
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93109-1228
Country	:	US
Telephone Number	:	805-259-8949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1187 COAST VILLAGE RD
Second Line	:	SUITE 10-J
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2737
Country	:	US
Telephone Number	:	805-259-8949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	07/08/2007

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