Provider Demographics
NPI:1295846491
Name:GRAY, REGINA BERICE (MSW)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:BERICE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 WALNUT ST
Mailing Address - Street 2:#201
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5400
Mailing Address - Country:US
Mailing Address - Phone:303-654-7334
Mailing Address - Fax:303-440-6244
Practice Address - Street 1:1634 WALNUT ST
Practice Address - Street 2:#201
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5400
Practice Address - Country:US
Practice Address - Phone:303-654-7334
Practice Address - Fax:303-440-6244
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9830331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical