Healthcare Provider Details

I. General information

NPI: 1891442455
Provider Name (Legal Business Name): JENNETTE SCHRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GLEN COVE AVE
GLEN COVE NY
11542-3438
US

IV. Provider business mailing address

15515 16TH DR
WHITESTONE NY
11357-3223
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-2388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: