Provider Demographics
NPI:1659048049
Name:MCCRAY, OCTAVIA S (LMHC)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:S
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159-64 HARLEM RIVER DR APT 13G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-1028
Mailing Address - Country:US
Mailing Address - Phone:917-569-1608
Mailing Address - Fax:
Practice Address - Street 1:159-64 HARLEM RIVER DR APT 13G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-1028
Practice Address - Country:US
Practice Address - Phone:917-569-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health