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General NPI Number Information
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NPI Number | 1336507029
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Entity Type | Organization
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Legal Business Name | GENIE RAVITAL, LLC
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 7127 GERMANTOWN AVE SUITE 2
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1855
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Country | US
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Telephone | 267-977-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 647 W ELLET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3428
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Country | US
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Telephone | 267-977-3008
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GENIE RAVITAL
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Credential | MSS, LCSW
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Telephone | 267-977-3008
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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 | CW014915
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License Number State | PA
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