Provider Demographics
NPI:1134297369
Name:HUMPAL, RAY LEONARD (ACSW, LISW)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:LEONARD
Last Name:HUMPAL
Suffix:
Gender:M
Credentials:ACSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 FOREST MEADOWS DR.
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-725-7831
Mailing Address - Fax:
Practice Address - Street 1:416 COLLEGE ST
Practice Address - Street 2:SUITE A
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1149
Practice Address - Country:US
Practice Address - Phone:330-334-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00004761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHUSW30351Medicare ID - Type Unspecified