MEDICARE: SARAH NICOLE RAY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L30034	OR

General Provider Information

NPI Number	:	1265257679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NICOLE RAY LCSW

Provider Business Mailing Address
First Line	:	1713 PENN LN
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1592
Country	:	US
Telephone Number	:	503-655-7725
Fax Number	:	503-655-7720

Provider Business Practice Location Address
First Line	:	1713 PENN LN
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-1592
Country	:	US
Telephone Number	:	503-655-7725
Fax Number	:	503-655-7720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	12/05/2024

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Directions to “ SARAH NICOLE RAY LCSW” Practice Location

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