Individual
PENELOPE RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1019 COMMERCIAL ST, GLEN COVE, ME 04856-3808
(207) 594-7585
Mailing address
1019 COMMERCIAL ST, ROCKPORT, ME 04856-3803
(207) 594-7585
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC1087
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006974
BLUE CROSS/BLUE SHIELD
ME
01
—
E002506
CHAMPUS ID
ME
Enumeration date
08/02/2006
Last updated
04/26/2013
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