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NPI Code Detail

MEDICARE: MS. JULIE ANN GRAY LCSW

MEDICARE:  MS. JULIE ANN GRAY  LCSW
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
11041C0700XClinical Social Worker149011369IL
21041C0700XClinical Social Worker28196CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101635906OTHERILBCBS
209932455OTHERILBCBS

General Provider Information

NPI Number : 1306947262
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JULIE ANN GRAY LCSW
Provider Business Mailing Address
First Line : 5715 S BROADWAY
Second Line : LOS ANGELES
City : LOS ANGELES
State : CA
Zip : 90037-4131
Country : US
Telephone Number : 323-948-0444
Fax Number : 323-948-0419
Provider Business Practice Location Address
First Line : 5715 S BROADWAY
Second Line : LOS ANGELES
City : LOS ANGELES
State : CA
Zip : 90037-4131
Country : US
Telephone Number : 323-948-0444
Fax Number : 323-948-0419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 06/15/2016

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Directions to “ MS. JULIE ANN GRAY LCSW” Practice Location

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