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General NPI Number Information
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NPI Number | 1124492681
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Entity Type | Individual
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Provider Name | JULIE KOVAC RAY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 4545 CONNECTICUT AVE NW APT 417
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City | WASHINGTON
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State | DC
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Zip | 20008-6021
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Country | US
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Telephone | 202-422-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 3033 BRANDYWINE ST NW
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City | WASHINGTON
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State | DC
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Zip | 20008-2141
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Country | US
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Telephone | 202-422-4004
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1000078
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810002702
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License Number State | VA
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