Provider Demographics
NPI:1083125785
Name:RAVICHANDAR, RITA ROSELINE (LSW)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:ROSELINE
Last Name:RAVICHANDAR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-9790
Mailing Address - Country:US
Mailing Address - Phone:215-997-2000
Mailing Address - Fax:
Practice Address - Street 1:160 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9790
Practice Address - Country:US
Practice Address - Phone:215-997-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134808104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty