Provider Demographics
NPI:1053125930
Name:REVAK, CATHERINE THERESA (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:THERESA
Last Name:REVAK
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S 15TH ST STE 1550
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4806
Mailing Address - Country:US
Mailing Address - Phone:407-917-2205
Mailing Address - Fax:
Practice Address - Street 1:101 S PALMWAY APT 8
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33460-4276
Practice Address - Country:US
Practice Address - Phone:407-917-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0242841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical