Provider Demographics
NPI:1649453317
Name:ELDREDGE, RONALD LEE
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LEE
Last Name:ELDREDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 CONGRESSIONAL VILLAGE DR
Mailing Address - Street 2:UNIT 8104
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-8380
Mailing Address - Country:US
Mailing Address - Phone:302-379-3032
Mailing Address - Fax:
Practice Address - Street 1:1880 CONGRESSIONAL VILLAGE DR
Practice Address - Street 2:UNIT 8104
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8380
Practice Address - Country:US
Practice Address - Phone:302-379-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECD-0000019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health