Doctor Name: | MRS. ANDREA GRAY |
NPI Number: | 1114211539 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.S |
License Number: | 353562091 |
Business Practice Address: | 2841 Thousand Acres Rd Delanson, NY - 120531917 |
Business Phone Number: | 5188756724 |
Business Fax Number: | |
Mailing Address: | 65 Benedict St, CASTLETON |
State: | NY |
Postal Code: | 120331119 |
Phone Number: | 5187283625 |
Fax Number: | |
NPI Enumeration Date: | 06/02/2011 |
NPI Last Update Date: | 06/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 353562091 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |