Provider Demographics
NPI:1346453701
Name:GRAY, THOMAS W (PHD, LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:GRAY
Suffix:
Gender:M
Credentials:PHD, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FINALE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-5059
Mailing Address - Country:US
Mailing Address - Phone:202-537-9351
Mailing Address - Fax:
Practice Address - Street 1:5028 WISCONSIN AVE-NW
Practice Address - Street 2:SUITE 400
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:202-537-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC30008941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical