Provider Demographics
NPI:1497754113
Name:GAY, MARY H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:H
Last Name:GAY
Suffix:
Gender:F
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:PO BOX 35395
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-0395
Mailing Address - Country:US
Mailing Address - Phone:804-378-3364
Mailing Address - Fax:
Practice Address - Street 1:2460 POTTERS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4322
Practice Address - Country:US
Practice Address - Phone:757-456-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003755OtherVALUE OPTIONS
VA132215OtherMHN
VA3080747OtherBCBS
VAO85422OtherOPTIMA/SENTARA
VA137760OtherCOMPSYCH
VA132215OtherTRICARE
VA8901112Medicaid
VA208793000OtherMAGELLAN
VA003755OtherVALUE OPTIONS
VAR59635Medicare UPIN