Healthcare Provider Details

I. General information

NPI: 1134932585
Provider Name (Legal Business Name): NEW SPARK THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 DURHAM CHAPEL HILL BLVD STE 230
DURHAM NC
27707-6239
US

IV. Provider business mailing address

3326 DURHAM CHAPEL HILL BLVD STE 230
DURHAM NC
27707-6239
US

V. Phone/Fax

Practice location:
  • Phone: 215-882-9949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MINAKSHI RATKALKAR
Title or Position: OWNER
Credential: PH.D., LCSW
Phone: 215-882-9949