Provider Demographics
NPI:1336242692
Name:WAYNE, GAY LEE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:GAY
Middle Name:LEE
Last Name:WAYNE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-8965
Mailing Address - Country:US
Mailing Address - Phone:315-673-9490
Mailing Address - Fax:
Practice Address - Street 1:157 GENESEE STREET
Practice Address - Street 2:BASEMENT
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3461
Practice Address - Country:US
Practice Address - Phone:315-253-0341
Practice Address - Fax:315-253-1129
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0174311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55959GMedicare ID - Type Unspecified