Provider Demographics
NPI:1730332271
Name:GRAY, MELISSA HILLARY (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:HILLARY
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 1:220 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7903
Mailing Address - Country:US
Mailing Address - Phone:718-921-0606
Mailing Address - Fax:718-491-6110
Practice Address - Street 1:1078 E 73RD ST UNIT 81
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5337
Practice Address - Country:US
Practice Address - Phone:347-254-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0518821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical