Provider Demographics
NPI:1205901162
Name:RIFE, RAYMOND W JR (MSW)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:W
Last Name:RIFE
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2250
Mailing Address - Country:US
Mailing Address - Phone:215-884-5059
Mailing Address - Fax:
Practice Address - Street 1:617 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2250
Practice Address - Country:US
Practice Address - Phone:215-884-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-120771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR07940Medicare UPIN