MEDICARE: BRANDI MARIE GRAY LMSW

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	12712-M	NV

General Provider Information

NPI Number	:	1336004134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI MARIE GRAY LMSW

Provider Business Mailing Address
First Line	:	6885 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1600
Country	:	US
Telephone Number	:	702-608-4220
Fax Number	:	702-479-7173

Provider Business Practice Location Address
First Line	:	6885 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1600
Country	:	US
Telephone Number	:	702-608-4220
Fax Number	:	702-479-7173

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

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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