Provider Demographics
NPI:1093725210
Name:GRAY, MARJORY ROBERTS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARJORY
Middle Name:ROBERTS
Last Name:GRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 STANTON RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-3519
Mailing Address - Country:US
Mailing Address - Phone:413-626-4966
Mailing Address - Fax:413-293-0693
Practice Address - Street 1:27 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-6461
Practice Address - Country:US
Practice Address - Phone:413-536-2662
Practice Address - Fax:413-536-2662
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51339Medicare ID - Type Unspecified