Provider Demographics
NPI:1235737644
Name:GRAY, STEPHANIE (CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 POLK ST FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7813
Mailing Address - Country:US
Mailing Address - Phone:415-554-8494
Mailing Address - Fax:415-554-8444
Practice Address - Street 1:730 POLK ST FL 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7813
Practice Address - Country:US
Practice Address - Phone:415-544-8494
Practice Address - Fax:414-544-8444
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker