Provider Demographics
NPI:1356678056
Name:LAY, RAHEEM RAVON (LCSW-S)
Entity Type:Individual
Prefix:DR
First Name:RAHEEM
Middle Name:RAVON
Last Name:LAY
Suffix:
Gender:M
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6819 BLACK DIAMOND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4557
Mailing Address - Country:US
Mailing Address - Phone:210-702-0719
Mailing Address - Fax:
Practice Address - Street 1:6819 BLACK DIAMOND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4557
Practice Address - Country:US
Practice Address - Phone:210-702-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082761041C0700X
OHI12003971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical