Provider Demographics
NPI:1619142817
Name:GARAY, TRACY L (LCSW)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:GARAY
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 1:20 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2216
Mailing Address - Country:US
Mailing Address - Phone:917-751-6968
Mailing Address - Fax:
Practice Address - Street 1:28 CARPENTER PL
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3503
Practice Address - Country:US
Practice Address - Phone:917-751-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0711331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical