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General NPI Number Information
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NPI Number | 1578019113
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Entity Type | Organization
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Legal Business Name | LYDIA WARD-GRAY, PSYD, LLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 19 SOUTH STREET SUITE 4
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City | PORTLAND
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State | ME
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Zip | 04101
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Country | US
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Telephone | 207-232-4508
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Fax |
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Provider Business Mailing Address
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Address Line | 19 SOUTH ST SUITE 4
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City | PORTLAND
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State | ME
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Zip | 04101-3963
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Country | US
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Telephone | 207-232-4508
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. LYDIA WARD-GRAY
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Credential | PSYD
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Telephone | 207-232-4508
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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 | PS881
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License Number State | ME
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