MEDICARE: MARY RAVETTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1467967133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RAVETTA

Provider Business Mailing Address
First Line	:	7335 E PALMER WASILLA HWY
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-7710
Country	:	US
Telephone Number	:	907-745-6200
Fax Number	:	907-745-6211

Provider Business Practice Location Address
First Line	:	7335 E PALMER WASILLA HWY
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-7710
Country	:	US
Telephone Number	:	907-745-6200
Fax Number	:	907-745-6211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	02/18/2025

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Directions to “ MARY RAVETTA ” Practice Location

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