Provider Demographics
NPI:1467811679
Name:RIVERS-WARD, UNDRETTA DEON
Entity Type:Individual
Prefix:MRS
First Name:UNDRETTA
Middle Name:DEON
Last Name:RIVERS-WARD
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 1:600 N OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2418
Mailing Address - Country:US
Mailing Address - Phone:610-566-7540
Mailing Address - Fax:610-566-7677
Practice Address - Street 1:600 N OLIVE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2418
Practice Address - Country:US
Practice Address - Phone:610-566-7540
Practice Address - Fax:610-566-7677
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical