MEDICARE: MS. PATRICIA ANTIONETTE GRAY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	078223-1	NY

General Provider Information

NPI Number	:	1134423403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA ANTIONETTE GRAY LCSW

Provider Business Mailing Address
First Line	:	222 N BROADWAY
Second Line	:	5C
City	:	YONKERS
State	:	NY
Zip	:	10701-2606
Country	:	US
Telephone Number	:	917-561-6321
Fax Number	:	917-529-5718

Provider Business Practice Location Address
First Line	:	2847 WEBSTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-3008
Country	:	US
Telephone Number	:	718-220-3076
Fax Number	:	917-529-5718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2010
Last Update Date	:	12/30/2010

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