Provider Demographics
NPI:1558983817
Name:GREY, REESE OLIVER (MA SCHOOL PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:REESE
Middle Name:OLIVER
Last Name:GREY
Suffix:
Gender:M
Credentials:MA SCHOOL PSYCHOLOGY
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:N
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-3042
Mailing Address - Country:US
Mailing Address - Phone:661-331-3476
Mailing Address - Fax:
Practice Address - Street 1:806 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2603
Practice Address - Country:US
Practice Address - Phone:603-524-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH130145103TS0200X
CA200041235103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH130145OtherNH DOE