Provider Demographics
NPI:1750823365
Name:HALL, RICKTESHA (MSW)
Entity Type:Individual
Prefix:
First Name:RICKTESHA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1719
Mailing Address - Country:US
Mailing Address - Phone:267-593-9387
Mailing Address - Fax:
Practice Address - Street 1:1401 WALNUT ST
Practice Address - Street 2:1350
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3128
Practice Address - Country:US
Practice Address - Phone:215-664-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104100000XMedicaid
PA103TBO200XMedicaid