Provider Demographics
NPI:1972624112
Name:RAGEN, THERESE (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:
Last Name:RAGEN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 AMHERST AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1152
Mailing Address - Country:US
Mailing Address - Phone:845-548-4325
Mailing Address - Fax:
Practice Address - Street 1:5 W 86TH ST APT 9C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3664
Practice Address - Country:US
Practice Address - Phone:845-548-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013004-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical