MEDICARE: SUSAN E. GREY APRN

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	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	000977	CT
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	000977	CT
3	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	000977	CT
4	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	000977	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7820698	OTHER	CT	AETNA PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2037373	OTHER	CT	CIGNA PROVIDER NUMBER
4	400000977CT02	OTHER	CT	ANTHEM BC/BS PROVIDER NUM
5	R33694	OTHER	CT	RN LICENSE
6	P3602617	OTHER	CT	OXFORD PROVIDER NUMBER
7	000977	OTHER	CT	APRN LICENSE
8	24692	OTHER	CT	CONTROLLED SUBST. REGISTR

General Provider Information

NPI Number	:	1952336893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E. GREY APRN

Provider Business Mailing Address
First Line	:	PO BOX 415933
Second Line	:	HARTFORD HOSPITAL PROFESSIONAL SERVICES
City	:	BOSTON
State	:	MA
Zip	:	02241-5933
Country	:	US
Telephone Number	:	860-545-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RETREAT AVENUE
Second Line	:	HARTFORD HOSPITAL PSYCHIATRY DEPT
City	:	HARTFORD
State	:	CT
Zip	:	06106-3310
Country	:	US
Telephone Number	:	860-545-7330
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/02/2011

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