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NPI Code Detail

MEDICARE: MR. TAYLOR W. GRAY PMHNP-BC, LICSW

MEDICARE: MR. TAYLOR W. GRAY PMHNP-BC, LICSW
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 Worker120185MA
2163W00000XRegistered NurseRN2326656MA
3363LP0808XPsychiatric/Mental Health Nurse PractitionerRN2326656MA

General Provider Information

NPI Number : 1770991218
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TAYLOR W. GRAY PMHNP-BC, LICSW
Provider Business Mailing Address
First Line : 300 SOUTH STREET
Second Line :
City : CHESTNUT HILL
State : MA
Zip : 02467-3694
Country : US
Telephone Number : 617-469-0300
Fax Number : 617-676-3460
Provider Business Practice Location Address
First Line : 300 SOUTH STREET
Second Line :
City : CHESTNUT HILL
State : MA
Zip : 02467-3694
Country : US
Telephone Number : 617-469-0300
Fax Number : 617-676-3460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2014
Last Update Date : 02/10/2020

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