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General NPI Number Information
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NPI Number | 1306541255
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Entity Type | Individual
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Provider Name | SAMANTHA BRAY LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 22 SHORE LN
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City | BAY SHORE
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State | NY
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Zip | 11706-8734
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Country | US
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Telephone | 631-647-4525
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Fax |
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Provider Business Mailing Address
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Address Line | 35 SILVER LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-4818
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Country | US
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Telephone | 516-578-7923
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 118501
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License Number State | NY
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