Provider Demographics
NPI:1174547004
Name:WRAY, MARILYN (LCSW-R)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 COLVIN BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6973
Mailing Address - Country:US
Mailing Address - Phone:716-510-7644
Mailing Address - Fax:716-875-4138
Practice Address - Street 1:1914 COLVIN BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6973
Practice Address - Country:US
Practice Address - Phone:716-510-7644
Practice Address - Fax:716-875-4138
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0188201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6208289OtherINDEPENDENT HEALTH
NY7482648OtherVALUE OPTIONS/GHI
NY000524117007OtherBLUE CROSS & BLUE SHIELD
NY00053094001OtherUNIVERA
NY000524117007OtherBLUE CROSS & BLUE SHIELD