Provider Demographics
NPI:1124281522
Name:RAY, KIMBERLY ANN (LSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:RAY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 EAST LINCOLN HWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320
Mailing Address - Country:US
Mailing Address - Phone:610-380-9982
Mailing Address - Fax:610-380-9987
Practice Address - Street 1:744 EAST LINCOLN HWY
Practice Address - Street 2:SUITE 410
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320
Practice Address - Country:US
Practice Address - Phone:610-380-9982
Practice Address - Fax:610-380-9987
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125545104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker