Provider Demographics
NPI:1811369440
Name:GRAY, CHRISTINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:GRAY
Other - Last Name:MOLINSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:125 ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054
Mailing Address - Country:US
Mailing Address - Phone:518-728-6528
Mailing Address - Fax:
Practice Address - Street 1:125 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054
Practice Address - Country:US
Practice Address - Phone:518-728-6528
Practice Address - Fax:518-475-9846
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088262-11041C0700X
NY096308-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical