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General NPI Number Information
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NPI Number | 1174547004
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Entity Type | Individual
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Provider Name | MARILYN WRAY LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 1914 COLVIN BLVD
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City | TONAWANDA
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State | NY
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Zip | 14150-6973
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Country | US
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Telephone | 716-510-7644
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Fax | 716-875-4138
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Provider Business Mailing Address
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Address Line | 1914 COLVIN BLVD
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City | TONAWANDA
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State | NY
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Zip | 14150-6973
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Country | US
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Telephone | 716-510-7644
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Fax | 716-875-4138
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 018820
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License Number State | NY
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