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General NPI Number Information
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NPI Number | 1295009397
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Entity Type | Organization
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Legal Business Name | ANNE MORGAN GRAY LTD
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 5305 MCKINLEY ST
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City | BETHESDA
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State | MD
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Zip | 20814-1413
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Country | US
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Telephone | 301-897-9591
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Fax |
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Provider Business Mailing Address
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Address Line | 5305 MCKINLEY ST
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City | BETHESDA
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State | MD
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Zip | 20814-1413
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Country | US
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Telephone | 301-897-9591
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT/TREASURER
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Name | MR. STEPHEN DAVID KORNBLATT
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Credential |
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Telephone | 301-452-3449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 03663
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License Number State | MD
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