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General NPI Number Information
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NPI Number | 1396251906
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Entity Type | Individual
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Provider Name | DENISE RAY
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Gender | Female
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 111 PRESIDENTIAL BLVD EAST LOBBY SUITE 237
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1012
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Country | US
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Telephone | 610-772-3939
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Fax | 215-877-3529
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Provider Business Mailing Address
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Address Line | 5745 WOODBINE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1236
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Country | US
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Telephone | 215-983-1488
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Fax | 215-877-3529
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW005909E
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License Number State | PA
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