Provider Demographics
NPI:1831261320
Name:GRAYBOW, SCOTT (LCSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:GRAYBOW
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11020 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4553
Mailing Address - Country:US
Mailing Address - Phone:917-715-5489
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 1100
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8115
Practice Address - Country:US
Practice Address - Phone:917-715-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0782401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical