Provider Demographics
NPI:1215619408
Name:GRIZZEL, RAY W III (LMHC)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:W
Last Name:GRIZZEL
Suffix:III
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 N JERUSALEM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1110
Mailing Address - Country:US
Mailing Address - Phone:516-351-1693
Mailing Address - Fax:
Practice Address - Street 1:2074 N JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1110
Practice Address - Country:US
Practice Address - Phone:516-351-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health