Provider Demographics
NPI:1508249152
Name:GREY, TWANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:TWANDA
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2231
Mailing Address - Country:US
Mailing Address - Phone:203-430-7865
Mailing Address - Fax:
Practice Address - Street 1:419 WHALLEY AVE STE 309
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3019
Practice Address - Country:US
Practice Address - Phone:203-823-9150
Practice Address - Fax:203-905-6809
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical