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NPI Code Detail

MEDICARE: ANTOINETTE GRAY

MEDICARE: ANTOINETTE GRAY
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
1101YA0400XAddiction (Substance Use Disorder) Counselor130510OH

General Provider Information

NPI Number : 1255875993
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTOINETTE GRAY
Provider Business Mailing Address
First Line : 1127 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115
Country : US
Telephone Number : 216-861-4246
Fax Number : 216-861-1156
Provider Business Practice Location Address
First Line : 1127 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2805
Country : US
Telephone Number : 216-861-4246
Fax Number : 216-861-1156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2016
Last Update Date : 12/15/2016

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Directions to “ ANTOINETTE GRAY ” Practice Location

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