Provider Demographics
NPI:1295986644
Name:FEARY-PRAY, PEGGY JOAN
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:JOAN
Last Name:FEARY-PRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 RICHLEY RD
Mailing Address - Street 2:
Mailing Address - City:CORFU
Mailing Address - State:NY
Mailing Address - Zip Code:14036-9623
Mailing Address - Country:US
Mailing Address - Phone:585-547-3342
Mailing Address - Fax:
Practice Address - Street 1:2620 RICHLEY RD
Practice Address - Street 2:
Practice Address - City:CORFU
Practice Address - State:NY
Practice Address - Zip Code:14036-9623
Practice Address - Country:US
Practice Address - Phone:585-547-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NYRO58040-1170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical