Provider Demographics
NPI:1841559499
Name:R E V E A L
Entity Type:Organization
Organization Name:R E V E A L
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANQUI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:917-652-1378
Mailing Address - Street 1:666 ONDERDONK AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2207
Mailing Address - Country:US
Mailing Address - Phone:917-652-1378
Mailing Address - Fax:347-889-6989
Practice Address - Street 1:666 ONDERDONK AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2207
Practice Address - Country:US
Practice Address - Phone:917-652-1378
Practice Address - Fax:347-889-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076961.1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty