Provider Demographics
NPI:1821711573
Name:GRAY, PETER WILLIAM (LICSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:WILLIAM
Last Name:GRAY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COVESIDE CT
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4601
Mailing Address - Country:US
Mailing Address - Phone:401-714-2280
Mailing Address - Fax:
Practice Address - Street 1:664 STEVENS RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4701
Practice Address - Country:US
Practice Address - Phone:508-397-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW037281041C0700X
MA1259111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical