MEDICARE: MRS. MAUDIE WATKINS RITCHIE LCSW-R; ACSW;BCD;BCE

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	1041C0700X	Clinical Social Worker	RO33628-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	117692	OTHER	VALUE OPTIONS
2	2335	OTHER	BCBS
3	6719	OTHER	EXCELLOS
4	323649	OTHER	MHN

General Provider Information

NPI Number	:	1811994932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUDIE WATKINS RITCHIE LCSW-R; ACSW;BCD;BCE

Provider Business Mailing Address
First Line	:	7000 E GENESEE ST
Second Line	:	BLDG B
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1131
Country	:	US
Telephone Number	:	315-251-0909
Fax Number	:	315-637-2643

Provider Business Practice Location Address
First Line	:	7000 E GENESEE ST
Second Line	:	BLDG B
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1131
Country	:	US
Telephone Number	:	315-251-0909
Fax Number	:	315-637-2643

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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