Healthcare Provider Details

I. General information

NPI: 1841714102
Provider Name (Legal Business Name): LINDSEY DAWN GRAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 MAPLE ST
BANGOR ME
04401-4035
US

IV. Provider business mailing address

351 MAPLE ST
BANGOR ME
04401-4035
US

V. Phone/Fax

Practice location:
  • Phone: 904-662-0126
  • Fax:
Mailing address:
  • Phone: 904-662-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW8342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: