Provider Demographics
NPI:1427767623
Name:ANYA RAVITZ
Entity type:Organization
Organization Name:ANYA RAVITZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-873-2969
Mailing Address - Street 1:661 W LAKE ST STE 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1034
Mailing Address - Country:US
Mailing Address - Phone:773-234-4038
Mailing Address - Fax:
Practice Address - Street 1:661 W LAKE ST STE 2S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1034
Practice Address - Country:US
Practice Address - Phone:773-873-2969
Practice Address - Fax:773-389-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty