1245447457 NPI number — MRS. LAURIE BETH GRAY LCSW ACSW

Table of content: MRS. LAURIE BETH GRAY LCSW ACSW (NPI 1245447457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245447457 NPI number — MRS. LAURIE BETH GRAY LCSW ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
LAURIE
Provider Middle Name:
BETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAUMAN
Provider Other First Name:
LAURIE
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CSW ACSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245447457
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:
213-20 A 69TH AVENUE
Provider Second Line Business Mailing Address:
APT A
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11364-2517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-229-7174
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47-37 UTOPIA PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURNDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11358-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-229-7174
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2007

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:  R0490811 , 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: 484976 . This is a "VALUE OPTIONS PROVIDER NU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7337878 . This is a "GHI PIN NUMBER" identifier . This identifiers is of the category "OTHER".




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