Provider Demographics
NPI:1679516645
Name:GRAYSON, RICHARD H (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:GRAYSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GARAGE RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3884
Mailing Address - Country:US
Mailing Address - Phone:203-262-4482
Mailing Address - Fax:
Practice Address - Street 1:7 GARAGE RD
Practice Address - Street 2:UNIT D
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3884
Practice Address - Country:US
Practice Address - Phone:203-262-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015711-1103G00000X
CT002567103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist