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General NPI Number Information
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NPI Number | 1336239367
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Entity Type | Individual
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Provider Name | KATHERINE L RAY MEDICAL PRACTICE
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 17 BISHOP ST
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City | PORTLAND
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State | ME
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Zip | 04103-2659
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Country | US
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Telephone | 207-871-1235
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Fax | 207-879-6161
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Provider Business Mailing Address
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Address Line | 899 RIVERSIDE ST
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City | PORTLAND
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State | ME
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Zip | 04103-1070
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Country | US
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Telephone | 207-871-1200
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Fax | 207-871-1232
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 016556
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License Number State | ME
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