Provider Demographics
NPI:1811994932
Name:RITCHIE, MAUDIE WATKINS (LCSW-R; ACSW;BCD;BCE)
Entity type:Individual
Prefix:MRS
First Name:MAUDIE
Middle Name:WATKINS
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:LCSW-R; ACSW;BCD;BCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 E GENESEE ST
Mailing Address - Street 2:BLDG B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1131
Mailing Address - Country:US
Mailing Address - Phone:315-251-0909
Mailing Address - Fax:315-637-2643
Practice Address - Street 1:7000 E GENESEE ST
Practice Address - Street 2:BLDG B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1131
Practice Address - Country:US
Practice Address - Phone:315-251-0909
Practice Address - Fax:315-637-2643
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO33628-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
117692OtherVALUE OPTIONS
2335OtherBCBS
6719OtherEXCELLOS
323649OtherMHN
6719OtherEXCELLOS