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General NPI Number Information
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NPI Number | 1457407686
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Entity Type | Individual
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Provider Name | MICHAEL REGAN TRAYNOR LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 70 SALISBURY RD
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City | DELMAR
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State | NY
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Zip | 12054-1213
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Country | US
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Telephone | 518-427-6613
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Fax | 518-207-0980
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Provider Business Mailing Address
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Address Line | 70 SALISBURY RD
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City | DELMAR
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State | NY
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Zip | 12054-1213
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Country | US
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Telephone | 518-427-6613
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Fax | 518-207-0980
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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 | RO49670-1
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License Number State | NY
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