Provider Demographics
NPI:1598900813
Name:GRAY, ROBERT BENJAMIN (LPCMH, CRC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:GRAY
Suffix:
Gender:M
Credentials:LPCMH, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 SIKA DR
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-1792
Mailing Address - Country:US
Mailing Address - Phone:302-422-7784
Mailing Address - Fax:
Practice Address - Street 1:349 SIKA DR
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-1792
Practice Address - Country:US
Practice Address - Phone:302-422-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000446101YM0800X, 101YP2500X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional