Provider Demographics
NPI:1730797911
Name:RAY, HARVETTA K (LCSW)
Entity type:Individual
Prefix:MS
First Name:HARVETTA
Middle Name:K
Last Name:RAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 WINDMILL LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7426
Mailing Address - Country:US
Mailing Address - Phone:502-500-9443
Mailing Address - Fax:
Practice Address - Street 1:1426 S 28TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1729
Practice Address - Country:US
Practice Address - Phone:502-500-9443
Practice Address - Fax:502-632-1432
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2548461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1041C0700XOtherTAXONOMY