MEDICARE: CANDACE 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	043639R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P589443	OTHER	NY	OXFORD HEALTH PLAN

General Provider Information

NPI Number	:	1801959283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE GRAY LCSW

Provider Business Mailing Address
First Line	:	309 W 86TH ST
Second Line	:	SUITE 2B
City	:	NEW YORK
State	:	NY
Zip	:	10024-3160
Country	:	US
Telephone Number	:	212-501-0151
Fax Number	:	212-684-3507

Provider Business Practice Location Address
First Line	:	309 W 86TH ST
Second Line	:	SUITE 2B
City	:	NEW YORK
State	:	NY
Zip	:	10024-3160
Country	:	US
Telephone Number	:	212-501-0151
Fax Number	:	212-684-3507

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/28/2009

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