=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114672573
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH K GRAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2022
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5281 ROUTE 22
-----------------------------------------------------
City | AMENIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12501-5347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-322-0598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5281 ROUTE 22
-----------------------------------------------------
City | AMENIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12501-5347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-322-0598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 221700000X
-----------------------------------------------------
Taxonomy Name | Art Therapist
-----------------------------------------------------
License Number | 002133
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 003759
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------