Provider Demographics
NPI:1134453004
Name:RAY, LEORA P
Entity type:Individual
Prefix:MRS
First Name:LEORA
Middle Name:P
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:121 HIGHLAND ACRES
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733
Mailing Address - Country:US
Mailing Address - Phone:607-967-8215
Mailing Address - Fax:
Practice Address - Street 1:121 HIGHLAND ACRES
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13733
Practice Address - Country:US
Practice Address - Phone:607-967-8215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist