Provider Demographics
NPI:1437444270
Name:RAY-SUBRAMANIAN, COREY E
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:E
Last Name:RAY-SUBRAMANIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:E
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 WEST WASHINGTON AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703
Mailing Address - Country:US
Mailing Address - Phone:608-960-9549
Mailing Address - Fax:
Practice Address - Street 1:660 WEST WASHINGTON AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703
Practice Address - Country:US
Practice Address - Phone:608-960-9549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI103TS0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool