Healthcare Provider Details

I. General information

NPI: 1922782929
Provider Name (Legal Business Name): CIARA CAPRICE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 SILVER PARK DR
SUITLAND MD
20746-2907
US

IV. Provider business mailing address

4301 FORBES BLVD STE B
LANHAM MD
20706-4446
US

V. Phone/Fax

Practice location:
  • Phone: 301-755-4203
  • Fax:
Mailing address:
  • Phone: 301-537-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: