Doctor Name: | MARCIA JEAN RAVILLE |
NPI Number: | 1003929134 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW-R |
License Number: | R047843-1 |
Business Practice Address: | 209 Park Street Malone, NY - 12953 |
Business Phone Number: | 5184833261 |
Business Fax Number: | 5184833383 |
Mailing Address: | Po Box 293, MALONE |
State: | NY |
Postal Code: | 129530293 |
Phone Number: | 5184815699 |
Fax Number: | |
NPI Enumeration Date: | 08/15/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | R047843-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |