Provider Demographics
NPI:1518587179
Name:GRAY, DANIELLE R
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:R
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8126 MARGARET PL UNIT 2R
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-8045
Mailing Address - Country:US
Mailing Address - Phone:347-845-9481
Mailing Address - Fax:
Practice Address - Street 1:240 ROCKAWAY AVE STE 3
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5841
Practice Address - Country:US
Practice Address - Phone:347-720-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health