Healthcare Provider Details

I. General information

NPI: 1902367592
Provider Name (Legal Business Name): ASHLEY GRAY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 COURT ST STE 260
BINGHAMTON NY
13901-3236
US

IV. Provider business mailing address

49 COURT ST STE 260
BINGHAMTON NY
13901-3236
US

V. Phone/Fax

Practice location:
  • Phone: 607-305-4204
  • Fax: 607-243-6799
Mailing address:
  • Phone: 607-305-4204
  • Fax: 607-243-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number023955
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number023955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: