Provider Demographics
NPI:1619926631
Name:MCGRAY, CHARLOTTE R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:R
Last Name:MCGRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 FRANK ORVIS
Mailing Address - Street 2:ADULT AND FAMILY PC
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443
Mailing Address - Country:US
Mailing Address - Phone:802-453-4991
Mailing Address - Fax:802-453-5947
Practice Address - Street 1:63 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-0929
Practice Address - Fax:802-453-5947
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT48684103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003321Medicaid
VT1003321Medicaid