MEDICARE: DANIELLE WRAY LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639656317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE WRAY LMSW

Provider Business Mailing Address
First Line	:	3303 ARBOR DR
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-3127
Country	:	US
Telephone Number	:	810-931-2415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 ARBOR DR
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-3127
Country	:	US
Telephone Number	:	313-403-4357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	06/19/2026

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