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General NPI Number Information
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NPI Number | 1831441625
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Entity Type | Individual
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Provider Name | SHAWN RYAN GRAY LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 1536 N JEFFERSON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6525
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Country | US
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Telephone | 904-670-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 1536 N JEFFERSON ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6525
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Country | US
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Telephone | 904-670-6900
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 18423
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW18511
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License Number State | FL
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