Healthcare Provider Details

I. General information

NPI: 1740227362
Provider Name (Legal Business Name): ANDREA GRAY-PINCUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S OYSTER BAY RD
BETHPAGE NY
11714-1030
US

IV. Provider business mailing address

310 BELLMORE RD
EAST MEADOW NY
11554-3539
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-8888
  • Fax:
Mailing address:
  • Phone: 516-343-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR049873
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: