Provider Demographics
NPI:1396251906
Name:RAY, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1236
Mailing Address - Country:US
Mailing Address - Phone:215-983-1488
Mailing Address - Fax:215-877-3529
Practice Address - Street 1:111 PRESIDENTIAL BLVD
Practice Address - Street 2:EAST LOBBY SUITE 237
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1012
Practice Address - Country:US
Practice Address - Phone:610-772-3939
Practice Address - Fax:215-877-3529
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW005909E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical