Provider Demographics
NPI:1114672573
Name:GRAY, SARAH K
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5281 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:AMENIA
Mailing Address - State:NY
Mailing Address - Zip Code:12501-5347
Mailing Address - Country:US
Mailing Address - Phone:646-322-0598
Mailing Address - Fax:
Practice Address - Street 1:5281 ROUTE 22
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-5347
Practice Address - Country:US
Practice Address - Phone:646-322-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002133221700000X
CT003759101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist