Provider Demographics
NPI:1154403145
Name:RAVITAL, AMEET (PHD)
Entity type:Individual
Prefix:
First Name:AMEET
Middle Name:
Last Name:RAVITAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 W ELLET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3428
Mailing Address - Country:US
Mailing Address - Phone:215-240-1449
Mailing Address - Fax:215-240-7012
Practice Address - Street 1:7127 GERMANTOWN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1855
Practice Address - Country:US
Practice Address - Phone:215-240-1449
Practice Address - Fax:215-240-7012
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical