Provider Demographics
NPI:1871622407
Name:BRAY, GERALD LANEAR (LCSWR)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LANEAR
Last Name:BRAY
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 91ST ST
Mailing Address - Street 2:APT 6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2443
Mailing Address - Country:US
Mailing Address - Phone:212-427-8043
Mailing Address - Fax:
Practice Address - Street 1:155 E 91ST ST
Practice Address - Street 2:APT 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2443
Practice Address - Country:US
Practice Address - Phone:212-996-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01902011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN25721Medicare ID - Type Unspecified