MEDICARE: DR. KARI BROOKS GRAY PHD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC0700X	Clinical Psychologist	023308	NY

General Provider Information

NPI Number	:	1477995363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARI BROOKS GRAY PHD

Provider Business Mailing Address
First Line	:	149 CLINTON AVE APT 1B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-2314
Country	:	US
Telephone Number	:	347-661-9537
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 W 88TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-2324
Country	:	US
Telephone Number	:	347-391-7724
Fax Number	:

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

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	04/02/2020

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