Provider Demographics
NPI:1225541691
Name:RIDGEWAY, EVELYN BROOKS (PHD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:BROOKS
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:PHD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:EARLY HEAD START, KARABOTS PEDIATRIC CARE CENTER
Mailing Address - Street 2:4865 MARKET STREET
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139
Mailing Address - Country:US
Mailing Address - Phone:267-425-9941
Mailing Address - Fax:267-425-9901
Practice Address - Street 1:4865 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3508
Practice Address - Country:US
Practice Address - Phone:267-425-9941
Practice Address - Fax:267-425-9901
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008753L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist