Provider Demographics
NPI:1437201563
Name:RAVITAL, GENIE BUD (MSS, LCSW)
Entity Type:Individual
Prefix:MS
First Name:GENIE
Middle Name:BUD
Last Name:RAVITAL
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 W ELLET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3428
Mailing Address - Country:US
Mailing Address - Phone:267-977-3008
Mailing Address - Fax:
Practice Address - Street 1:7127 GERMANTOWN AVE
Practice Address - Street 2:STE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1855
Practice Address - Country:US
Practice Address - Phone:267-977-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0149151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical