Healthcare Provider Details

I. General information

NPI: 1134423403
Provider Name (Legal Business Name): PATRICIA ANTIONETTE GRAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2847 WEBSTER AVE
BRONX NY
10458-3008
US

IV. Provider business mailing address

222 N BROADWAY 5C
YONKERS NY
10701-2606
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-3076
  • Fax: 917-529-5718
Mailing address:
  • Phone: 917-561-6321
  • Fax: 917-529-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078223-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: