Provider Demographics
NPI:1528399789
Name:ECKARDT, RALPH WILLIAM (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WILLIAM
Last Name:ECKARDT
Suffix:
Gender:M
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2226
Mailing Address - Country:US
Mailing Address - Phone:610-623-2778
Mailing Address - Fax:
Practice Address - Street 1:313 SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2226
Practice Address - Country:US
Practice Address - Phone:610-623-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000123L1041C0700X
NJ37F100102700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist