Provider Demographics
NPI:1174691018
Name:RIPELLINO, DANE CARLO (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANE
Middle Name:CARLO
Last Name:RIPELLINO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 ROBINSON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7633
Mailing Address - Country:US
Mailing Address - Phone:617-236-4646
Mailing Address - Fax:
Practice Address - Street 1:1807 ROBINSON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7633
Practice Address - Country:US
Practice Address - Phone:617-236-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22722103T00000X
MA6161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist