Provider Demographics
NPI:1073847257
Name:GRAY, DEVON ROBERT
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:ROBERT
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 TILESTON RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5310
Mailing Address - Country:US
Mailing Address - Phone:781-534-2828
Mailing Address - Fax:
Practice Address - Street 1:35 SUMMER ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3469
Practice Address - Country:US
Practice Address - Phone:508-942-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor