Provider Demographics
NPI:1215024799
Name:GRAY, CYNTHIA AIDINA (LSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:AIDINA
Last Name:GRAY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-1616
Mailing Address - Country:US
Mailing Address - Phone:413-582-7961
Mailing Address - Fax:413-582-7963
Practice Address - Street 1:518 PLEASANT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3997
Practice Address - Country:US
Practice Address - Phone:413-582-7961
Practice Address - Fax:413-582-7963
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3015778104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker