Healthcare Provider Details

I. General information

NPI: 1982805016
Provider Name (Legal Business Name): CATHLEEN GRAY PHD,LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WISCONSIN AVE NW SUITE 502
WASHINGTON DC
20016-4629
US

IV. Provider business mailing address

4801 WISCONSIN AVE NW SUITE 502
WASHINGTON DC
20016-4629
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-5922
  • Fax:
Mailing address:
  • Phone: 202-537-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC300957
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number00361
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: