Healthcare Provider Details

I. General information

NPI: 1972904001
Provider Name (Legal Business Name): JULIE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321-B CANDELARIA RD NE SUITE 403
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

PO BOX 93792
ALBUQUERQUE NM
87199-3792
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-4243
  • Fax: 505-808-4960
Mailing address:
  • Phone: 505-750-4243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: