Healthcare Provider Details

I. General information

NPI: 1609189307
Provider Name (Legal Business Name): RAYNA E TERRY-TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90-27 SUTPHIN BLVD, 5TH FLOOR TRANSITIONAL SERVICES OF NEW YORK
JAMAICA NY
11435
US

IV. Provider business mailing address

17 ALABAMA AVE
HEMPSTEAD NY
11550-7210
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax:
Mailing address:
  • Phone: 516-457-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR051889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: