Provider Demographics
NPI:1093463994
Name:WOIDISLAWSKY, RITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:WOIDISLAWSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 OLD YORK RD STE 110B110B
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2318
Mailing Address - Country:US
Mailing Address - Phone:267-278-0919
Mailing Address - Fax:
Practice Address - Street 1:1911 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5732
Practice Address - Country:US
Practice Address - Phone:267-278-0919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006858103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty