Provider Demographics
NPI:1124492681
Name:RAY, JULIE KOVAC (PHD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KOVAC
Last Name:RAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 BRANDYWINE ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2141
Mailing Address - Country:US
Mailing Address - Phone:202-422-4004
Mailing Address - Fax:
Practice Address - Street 1:4545 CONNECTICUT AVE NW APT 417
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-6021
Practice Address - Country:US
Practice Address - Phone:202-422-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000078103TC0700X
VA0810002702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical