Provider Demographics
NPI:1861125593
Name:RADATTI, BALLY (LPC)
Entity type:Individual
Prefix:
First Name:BALLY
Middle Name:
Last Name:RADATTI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 BAINBRIDGE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2402
Mailing Address - Country:US
Mailing Address - Phone:215-859-8500
Mailing Address - Fax:
Practice Address - Street 1:1819 JOHN F KENNEDY BLVD STE 302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1729
Practice Address - Country:US
Practice Address - Phone:610-265-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional