MEDICARE: MS. CARRIE ELIZABETH GRAY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	93629	CA

General Provider Information

NPI Number	:	1013463132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE ELIZABETH GRAY LMFT

Provider Business Mailing Address
First Line	:	PO BOX 5457
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-0457
Country	:	US
Telephone Number	:	510-775-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 COLLEGE AVE STE 4
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-1416
Country	:	US
Telephone Number	:	510-775-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2016
Last Update Date	:	08/29/2016

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