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General NPI Number Information
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NPI Number | 1225541691
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Entity Type | Individual
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Provider Name | EVELYN BROOKS RIDGEWAY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 4865 MARKET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3508
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Country | US
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Telephone | 267-425-9941
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Fax | 267-425-9901
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Provider Business Mailing Address
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Address Line | EARLY HEAD START, KARABOTS PEDIATRIC CARE CENTER 4865 MARKET STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19139
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Country | US
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Telephone | 267-425-9941
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Fax | 267-425-9901
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS008753L
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License Number State | PA
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