Provider Demographics
NPI:1598894529
Name:GRAY, KELSEY ANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ANN
Last Name:GRAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CROSBY RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2570
Mailing Address - Country:US
Mailing Address - Phone:508-280-8385
Mailing Address - Fax:
Practice Address - Street 1:411 ROUTE 6A
Practice Address - Street 2:BUILDING 5, UNIT C
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1843
Practice Address - Country:US
Practice Address - Phone:508-280-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker