MEDICARE: MRS. MARCIA A GRAY LMFT

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
1	106H00000X	Marriage & Family Therapist	1304	MA

General Provider Information

NPI Number	:	1770790511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCIA A GRAY LMFT

Provider Business Mailing Address
First Line	:	3 BRENTWOOD WAY
Second Line	:
City	:	IPSWICH
State	:	MA
Zip	:	01938-1176
Country	:	US
Telephone Number	:	978-356-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 RANTOUL ST
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-4822
Country	:	US
Telephone Number	:	978-927-9410
Fax Number	:	978-922-6141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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