Healthcare Provider Details

I. General information

NPI: 1437884210
Provider Name (Legal Business Name): JESSICA RAY MSW, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 MARKET ST
YOUNGSTOWN OH
44507-1127
US

IV. Provider business mailing address

1507 MARKET ST
YOUNGSTOWN OH
44507-1127
US

V. Phone/Fax

Practice location:
  • Phone: 740-802-1559
  • Fax:
Mailing address:
  • Phone: 330-744-5143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2512384
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: