Provider Demographics
NPI:1902795677
Name:DAVIS, RITTERDALE (CASAC-T)
Entity type:Individual
Prefix:
First Name:RITTERDALE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 BOONE AVE APT 4C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-5776
Mailing Address - Country:US
Mailing Address - Phone:786-856-0614
Mailing Address - Fax:
Practice Address - Street 1:344 W 44TH STREET
Practice Address - Street 2:205
Practice Address - City:MANHATTAN
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:212-913-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health