Provider Demographics
NPI:1467063701
Name:GRAY, MARIE (MS ED)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MALCOLM X BLVD APT 8R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3026
Mailing Address - Country:US
Mailing Address - Phone:646-574-9134
Mailing Address - Fax:
Practice Address - Street 1:12 N BROADWAY APT 2B
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-7064
Practice Address - Country:US
Practice Address - Phone:917-450-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency