Provider Demographics
NPI:1639959679
Name:GRAY, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BASIL AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21915-1110
Mailing Address - Country:US
Mailing Address - Phone:443-496-5579
Mailing Address - Fax:
Practice Address - Street 1:207 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1189
Practice Address - Country:US
Practice Address - Phone:410-758-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD268931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical