Healthcare Provider Details

I. General information

NPI: 1144694506
Provider Name (Legal Business Name): MINAKSHI RATKALKAR PH.D., LCSW, CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MINA RATKALKAR

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 02/06/2021
Certification Date: 02/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6409 FAYETTEVILLE RD STE 120-189
DURHAM NC
27713-6297
US

IV. Provider business mailing address

6409 FAYETTEVILLE RD STE 120-189
DURHAM NC
27713-6297
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 12424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: