Provider Demographics
NPI:1144544404
Name:GREY, HEATHER (ATR-BC, LCAT)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 VEEDER DR
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2512
Mailing Address - Country:US
Mailing Address - Phone:516-902-8286
Mailing Address - Fax:
Practice Address - Street 1:1234 W BROADWAY
Practice Address - Street 2:SUTIE 203
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1929
Practice Address - Country:US
Practice Address - Phone:516-330-4983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001313-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health