Healthcare Provider Details

I. General information

NPI: 1497955496
Provider Name (Legal Business Name): MONICA R. GREY, L.C.S.W., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 S.W, STATE ROAD 200 SUITE 102
OCALA FL
34481
US

IV. Provider business mailing address

3954 NW 41ST LN
GAINESVILLE FL
32606-4556
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-3699
  • Fax:
Mailing address:
  • Phone: 352-377-4380
  • Fax: 352-377-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW4384
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA50355
License Number StateFL

VIII. Authorized Official

Name: MONICA RANYD GREY
Title or Position: OWNER
Credential: L.C.S.W.
Phone: 352-377-4380