Provider Demographics
NPI:1093806887
Name:GRAY, DONOVAN SEYMOUR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DONOVAN
Middle Name:SEYMOUR
Last Name:GRAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18901 S.W. 197 AVE.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187
Mailing Address - Country:US
Mailing Address - Phone:305-282-9226
Mailing Address - Fax:305-757-4465
Practice Address - Street 1:18901 S.W. 197 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187
Practice Address - Country:US
Practice Address - Phone:305-282-9226
Practice Address - Fax:305-757-2387
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW3192101YM0800X
FLSW125891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health