Healthcare Provider Details

I. General information

NPI: 1992627988
Provider Name (Legal Business Name): NATHANIEL STEPHEN RAY LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 PINE HALL RD STE 100
STATE COLLEGE PA
16801-5107
US

IV. Provider business mailing address

1951 PINE HALL RD STE 100
STATE COLLEGE PA
16801-5107
US

V. Phone/Fax

Practice location:
  • Phone: 814-308-8375
  • Fax: 814-308-8126
Mailing address:
  • Phone: 814-308-8375
  • Fax: 814-308-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW144516
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: