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NPI Code Detail

MEDICARE: ROBYN GRAY LICSW, LCSW-C

MEDICARE: ROBYN GRAY LICSW, LCSW-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker23890MD

General Provider Information

NPI Number : 1679197412
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBYN GRAY LICSW, LCSW-C
Provider Business Mailing Address
First Line : 9520 MARLBORO PIKE STE 201
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-3666
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9520 MARLBORO PIKE STE 201
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-3666
Country : US
Telephone Number : 301-332-0775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2020
Last Update Date : 06/07/2020

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