Individual
DR. JONATHAN MICHAEL RAVARINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
201 S 1460 E RM 426, SALT LAKE CITY, UT 84112-9061
(801) 918-5275
Mailing address
2665 S 1900 E, SALT LAKE CITY, UT 84106-4155
(801) 918-5275
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5179442-2501
UT
1041C0700X
Clinical Social Worker
5179442-3501
UT
Other
Enumeration date
02/09/2010
Last updated
11/02/2010
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