MEDICARE: MS. CYNTHIA AIDINA GRAY LSW

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	104100000X	Social Worker	3015778	MA

General Provider Information

NPI Number	:	1215024799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA AIDINA GRAY LSW

Provider Business Mailing Address
First Line	:	136 CAMBRIDGE ST
Second Line	:
City	:	FEEDING HILLS
State	:	MA
Zip	:	01030-1616
Country	:	US
Telephone Number	:	413-582-7961
Fax Number	:	413-582-7963

Provider Business Practice Location Address
First Line	:	518 PLEASANT ST
Second Line	:	SUITE 100
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-3997
Country	:	US
Telephone Number	:	413-582-7961
Fax Number	:	413-582-7963

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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