Healthcare Provider Details

I. General information

NPI: 1083282917
Provider Name (Legal Business Name): ELIZABETH GRAY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PENNSYLVANIA AVE
IRWIN PA
15642-3552
US

IV. Provider business mailing address

100 PENNSYLVANIA AVE
IRWIN PA
15642-3552
US

V. Phone/Fax

Practice location:
  • Phone: 724-420-4206
  • Fax:
Mailing address:
  • Phone: 724-420-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS020615
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: