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General NPI Number Information
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NPI Number | 1952384158
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Entity Type | Individual
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Provider Name | JUDITH ANNE GRAY APRN
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Gender | Female
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 25485 HARCUM WHARF RD
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City | EDEN
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State | MD
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Zip | 21822-2167
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Country | US
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Telephone | 443-880-2995
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Fax | 877-817-7197
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Provider Business Mailing Address
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Address Line | 25485 HARCUM WHARF RD
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City | EDEN
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State | MD
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Zip | 21822-2167
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Country | US
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Telephone | 443-880-2995
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Fax | 817-877-7197
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R039465
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License Number State | MD
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