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General NPI Number Information
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NPI Number | 1619926631
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Entity Type | Individual
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Provider Name | CHARLOTTE R MCGRAY PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 63 MAPLE ST
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City | MIDDLEBURY
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State | VT
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Zip | 05753
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Country | US
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Telephone | 802-388-0929
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Fax | 802-453-5947
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Provider Business Mailing Address
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Address Line | 690 FRANK ORVIS ADULT AND FAMILY PC
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City | BRISTOL
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State | VT
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Zip | 05443
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Country | US
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Telephone | 802-453-4991
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Fax | 802-453-5947
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 48684
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License Number State | VT
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