Organization
GENIE RAVITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENIE RAVITAL MSS, LCSW (OWNER)
(267) 977-3008
Entity
Organization
Contact information
Practice address
7127 GERMANTOWN AVE, SUITE 2, PHILADELPHIA, PA 19119-1855
(267) 977-3008
Mailing address
647 W ELLET ST, PHILADELPHIA, PA 19119-3428
(267) 977-3008
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW014915
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001934497
—
PA
Enumeration date
02/09/2016
Last updated
02/09/2016
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