Provider Demographics
NPI:1881243830
Name:RAVITS, EMILY M (LICENSED INDEPENDEN)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:RAVITS
Suffix:
Gender:F
Credentials:LICENSED INDEPENDEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 INTERNATIONAL DRIVE SUITE 300
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-2562
Mailing Address - Country:US
Mailing Address - Phone:952-250-3513
Mailing Address - Fax:612-314-8839
Practice Address - Street 1:7900 INTERNATIONAL DRIVE SUITE 300
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-2562
Practice Address - Country:US
Practice Address - Phone:952-250-3513
Practice Address - Fax:612-314-8839
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical