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Individual
JONNA LYNN REVITZ
Active
Individual
JONNA LYNN REVITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0690431
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00069043
—
NY
Enumeration date
10/09/2006
Last updated
07/08/2007
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