Provider Demographics
NPI:1629964671
Name:RAVAL, GEETA (MS)
Entity type:Individual
Prefix:
First Name:GEETA
Middle Name:
Last Name:RAVAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2119 N SUMMIT AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1309
Mailing Address - Country:US
Mailing Address - Phone:917-345-6556
Mailing Address - Fax:
Practice Address - Street 1:1442 S 92ND ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4235
Practice Address - Country:US
Practice Address - Phone:414-897-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8484226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health