1821094095 NPI number — DAVID F GRAY LCSW

Table of content: DAVID F GRAY LCSW (NPI 1821094095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821094095 NPI number — DAVID F GRAY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
DAVID
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821094095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 BRYANT WOODS S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14228-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-689-3333
Provider Business Mailing Address Fax Number:
716-689-9866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 BRYANT WOODS S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14228-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-689-3333
Provider Business Practice Location Address Fax Number:
716-689-9866
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R022709 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000505677007 . This is a "HEALTH INTEGRATED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000505677007 . This is a "BC/BS OF WNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10767996 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6290332 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00025664801 . This is a "UNIVERA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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