Provider Demographics
NPI:1063841377
Name:RAVELO, CAMILA
Entity Type:Individual
Prefix:
First Name:CAMILA
Middle Name:
Last Name:RAVELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2419
Mailing Address - Country:US
Mailing Address - Phone:973-951-7371
Mailing Address - Fax:973-860-4427
Practice Address - Street 1:58 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-2419
Practice Address - Country:US
Practice Address - Phone:973-951-7371
Practice Address - Fax:973-860-4427
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00851600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist