Provider Demographics
NPI:1659429918
Name:RAVICZ, LI (PHD)
Entity Type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:RAVICZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N 36TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8868
Mailing Address - Country:US
Mailing Address - Phone:206-909-5574
Mailing Address - Fax:206-547-2442
Practice Address - Street 1:701 N 36TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8868
Practice Address - Country:US
Practice Address - Phone:206-909-5574
Practice Address - Fax:206-547-2442
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2395103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB393837Medicare ID - Type UnspecifiedMEDICARE NUMBER