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General NPI Number Information
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NPI Number | 1477016699
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Entity Type | Individual
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Provider Name | SYBIL SMITH-GRAY PHD.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 1447 YORK RD STE 506
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City | LUTHERVILLE
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State | MD
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Zip | 21093-6022
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Country | US
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Telephone | 410-825-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 2503 AMBER ORCHARD CT W UNIT 302
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City | ODENTON
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State | MD
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Zip | 21113-3634
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Country | US
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Telephone | 301-204-3284
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 03521
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License Number State | MD
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