Provider Demographics
NPI:1245447457
Name:GRAY, LAURIE BETH (LCSW ACSW)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:BETH
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW ACSW
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:BETH
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW ACSW
Mailing Address - Street 1:213-20 A 69TH AVENUE
Mailing Address - Street 2:APT A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2517
Mailing Address - Country:US
Mailing Address - Phone:718-229-7174
Mailing Address - Fax:
Practice Address - Street 1:47-37 UTOPIA PARKWAY
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:NY
Practice Address - Zip Code:11358-3840
Practice Address - Country:US
Practice Address - Phone:718-229-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04908111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
484976OtherVALUE OPTIONS PROVIDER NU
7337878OtherGHI PIN NUMBER