Provider Demographics
NPI:1265833966
Name:GRAY, MICHAEL A (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
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 1:875 DEKALB AVE APT 6E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6246
Mailing Address - Country:US
Mailing Address - Phone:929-359-3914
Mailing Address - Fax:929-493-4006
Practice Address - Street 1:141 S 5TH ST OFC WEST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5597
Practice Address - Country:US
Practice Address - Phone:929-359-3914
Practice Address - Fax:929-493-4006
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0873421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical