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General NPI Number Information
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NPI Number | 1124532411
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Entity Type | Individual
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Provider Name | TIMOTHY E GRAY BCBA, LBA
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Gender | Male
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 11/12/2022
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Provider Practice Location Address
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Address Line | 1200 CREAMERY LN
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City | BELCAMP
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State | MD
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Zip | 21017-1499
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Country | US
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Telephone | 443-518-6559
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CREAMERY LN
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City | BELCAMP
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State | MD
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Zip | 21017-1499
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Country | US
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Telephone | 434-518-6559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 370
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License Number State | MD
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