Provider Demographics
NPI:1770477978
Name:GRAY-DODSON, JADE CHRISTINA
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:CHRISTINA
Last Name:GRAY-DODSON
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 1:64 BURBANK ST APT 12
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3609
Mailing Address - Country:US
Mailing Address - Phone:857-500-3209
Mailing Address - Fax:
Practice Address - Street 1:64 BURBANK ST APT 12
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3609
Practice Address - Country:US
Practice Address - Phone:857-500-3209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health