MEDICARE: MS. CYNTHIA ELIZABETH 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
1	1041C0700X	Clinical Social Worker	27747	CA

General Provider Information

NPI Number	:	1952567695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA ELIZABETH GRAY LCSW

Provider Business Mailing Address
First Line	:	470 CHADBOURNE RD STE F
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-9600
Country	:	US
Telephone Number	:	707-557-4560
Fax Number	:	707-557-7909

Provider Business Practice Location Address
First Line	:	470 CHADBOURNE RD STE F
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-9600
Country	:	US
Telephone Number	:	707-557-4560
Fax Number	:	707-557-7909

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

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	11/23/2011

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