Provider Demographics
NPI:1801959283
Name:GRAY, CANDACE (LCSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W 86TH ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3160
Mailing Address - Country:US
Mailing Address - Phone:212-501-0151
Mailing Address - Fax:212-684-3507
Practice Address - Street 1:309 W 86TH ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3160
Practice Address - Country:US
Practice Address - Phone:212-501-0151
Practice Address - Fax:212-684-3507
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043639R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP589443OtherOXFORD HEALTH PLAN
NYP589443OtherOXFORD HEALTH PLAN