Healthcare Provider Details

I. General information

NPI: 1699692376
Provider Name (Legal Business Name): JULIETTE MIEKO GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SAW MILL RIVER RD STE LL-4
HAWTHORNE NY
10532-1535
US

IV. Provider business mailing address

40 SAW MILL RIVER RD STE LL-4
HAWTHORNE NY
10532-1535
US

V. Phone/Fax

Practice location:
  • Phone: 845-614-8481
  • Fax:
Mailing address:
  • Phone: 845-614-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP130668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: