MEDICARE: MS. HARVETTA K RAY LCSW

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	254846	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1041C0700X	OTHER	KY	TAXONOMY

General Provider Information

NPI Number	:	1730797911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HARVETTA K RAY LCSW

Provider Business Mailing Address
First Line	:	1205 WINDMILL LN
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-7426
Country	:	US
Telephone Number	:	502-500-9443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 S 28TH ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-1729
Country	:	US
Telephone Number	:	502-500-9443
Fax Number	:	502-632-1432

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

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	07/14/2020

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