| Genie Ravital, Llc | |
|
7127 Germantown Ave Suite 2 Philadelphia PA 19119-1855 | |
| (267) 977-3008 | |
| Not Available |
| Full Name | Genie Ravital, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 7127 Germantown Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Genie Ravital (OWNER) |
| Authorized Official Contact | 2679773008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genie Ravital, Llc 647 W Ellet St Philadelphia PA 19119-3428 Ph: (267) 977-3008 | Genie Ravital, Llc 7127 Germantown Ave Suite 2 Philadelphia PA 19119-1855 Ph: (267) 977-3008 |
| NPI Number | 1336507029 |
|---|---|
| Provider Enumeration Date | 02/09/2016 |
| Last Update Date | 02/09/2016 |
| Medicare PECOS PAC ID | 7315238771 |
|---|---|
| Medicare Enrollment ID | O20160615002191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336507029 | NPI | - | NPPES |
| 001934497 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CW014915 (Pennsylvania) | Primary |
| Provider Name | Genie Bud Ravital |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437201563 PECOS PAC ID: 8224329685 Enrollment ID: I20160615002440 |
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