Provider Demographics
NPI:1730344052
Name:GREY, DEIRDRE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3446 DRY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:FALCONER
Mailing Address - State:NY
Mailing Address - Zip Code:14733-9736
Mailing Address - Country:US
Mailing Address - Phone:716-725-2219
Mailing Address - Fax:
Practice Address - Street 1:3446 DRY BROOK RD
Practice Address - Street 2:
Practice Address - City:FALCONER
Practice Address - State:NY
Practice Address - Zip Code:14733-9736
Practice Address - Country:US
Practice Address - Phone:716-725-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068176-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52326AMedicare UPIN