Provider Demographics
NPI:1083672448
Name:GREY, MONICA RANDY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:RANDY
Last Name:GREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3954 NW 41ST LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4556
Mailing Address - Country:US
Mailing Address - Phone:522-222-8126
Mailing Address - Fax:352-377-4380
Practice Address - Street 1:2610 NW 43RD ST STE 1A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6677
Practice Address - Country:US
Practice Address - Phone:352-448-5836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW4384101YM0800X, 1041C0700X
FLMA50355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28149Medicare ID - Type Unspecified