MEDICARE: ELIZABETH RAY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	1041S0200X	School Social Worker
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1376338632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RAY

Provider Business Mailing Address
First Line	:	136 W 84TH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-2820
Country	:	US
Telephone Number	:	323-216-3428
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 W 84TH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90003-2820
Country	:	US
Telephone Number	:	323-216-3428
Fax Number	:

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

Provider Enumeration Date	:	04/09/2025
Last Update Date	:	04/09/2025

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Directions to “ ELIZABETH RAY ” Practice Location

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