MEDICARE: DR. RAHEEM RAVON LAY LCSW-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	108276	TX
2	1041C0700X	Clinical Social Worker	I1200397	OH

General Provider Information

NPI Number	:	1356678056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAHEEM RAVON LAY LCSW-S

Provider Business Mailing Address
First Line	:	6819 BLACK DIAMOND
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4557
Country	:	US
Telephone Number	:	210-702-0719
Fax Number	:

Provider Business Practice Location Address
First Line	:	6819 BLACK DIAMOND
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-4557
Country	:	US
Telephone Number	:	210-702-0719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	08/24/2023

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