Provider Demographics
NPI:1497955496
Name:MONICA R. GREY, L.C.S.W., P.A.
Entity Type:Organization
Organization Name:MONICA R. GREY, L.C.S.W., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:RANYD
Authorized Official - Last Name:GREY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:352-377-4380
Mailing Address - Street 1:3954 NW 41ST LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4556
Mailing Address - Country:US
Mailing Address - Phone:352-377-4380
Mailing Address - Fax:352-377-4380
Practice Address - Street 1:8750 S.W, STATE ROAD 200 SUITE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481
Practice Address - Country:US
Practice Address - Phone:352-629-3699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW43841041C0700X
FLMA50355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8149Medicare UPIN