Healthcare Provider Details

I. General information

NPI: 1083672448
Provider Name (Legal Business Name): MONICA RANDY GREY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 NW 43RD ST STE 1A
GAINESVILLE FL
32606-6677
US

IV. Provider business mailing address

3954 NW 41ST LN
GAINESVILLE FL
32606-4556
US

V. Phone/Fax

Practice location:
  • Phone: 352-448-5836
  • Fax:
Mailing address:
  • Phone: 522-222-8126
  • Fax: 352-377-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW4384
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA50355
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: