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General NPI Number Information
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NPI Number | 1053125930
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Entity Type | Individual
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Provider Name | CATHERINE THERESA REVAK DSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 101 S PALMWAY APT 8
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City | LAKE WORTH BEACH
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State | FL
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Zip | 33460-4276
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Country | US
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Telephone | 407-917-2205
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Fax |
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Provider Business Mailing Address
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Address Line | 30 S 15TH ST STE 1550
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City | PHILADELPHIA
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State | PA
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Zip | 19102-4806
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Country | US
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Telephone | 407-917-2205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW024284
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW24235
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License Number State | FL
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