Provider Demographics
NPI:1376258822
Name:RYSAVY, CLAIRE (LMSW)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:RYSAVY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N BROAD ST APT 213
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-5149
Mailing Address - Country:US
Mailing Address - Phone:201-306-3978
Mailing Address - Fax:
Practice Address - Street 1:1220 N BROAD ST APT 213
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-5149
Practice Address - Country:US
Practice Address - Phone:201-306-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1398491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical