Provider Demographics
NPI:1063783009
Name:RAMOS, MICHAEL TYLER (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TYLER
Last Name:RAMOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 18TH ST
Mailing Address - Street 2:204
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5957
Mailing Address - Country:US
Mailing Address - Phone:267-702-4426
Mailing Address - Fax:215-352-0410
Practice Address - Street 1:201 S 18TH ST
Practice Address - Street 2:204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5957
Practice Address - Country:US
Practice Address - Phone:267-702-4426
Practice Address - Fax:215-352-0410
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0189351041C0700X
PASW128877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical