Basic Information
| Provider Information | |||||||||
| NPI: | 1609189307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERRY-TAYLOR | ||||||||
| FirstName: | RAYNA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 ALABAMA AVE | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115507210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164572353 | ||||||||
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| Practice Location | |||||||||
| Address1: | 90-27 SUTPHIN BLVD, 5TH FLOOR | ||||||||
| Address2: | TRANSITIONAL SERVICES OF NEW YORK | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185268400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2010 | ||||||||
| LastUpdateDate: | 07/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R051889 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.