Healthcare Provider Details

I. General information

NPI: 1952858144
Provider Name (Legal Business Name): JACLYN GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 COURT ST
BRISTOL RI
02809-2207
US

IV. Provider business mailing address

9 COURT ST
BRISTOL RI
02809-2207
US

V. Phone/Fax

Practice location:
  • Phone: 401-842-0009
  • Fax:
Mailing address:
  • Phone: 401-864-1948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04804
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: