Provider Demographics
NPI:1922782929
Name:GRAY, CIARA CAPRICE
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:CAPRICE
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 1:4301 FORBES BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4446
Mailing Address - Country:US
Mailing Address - Phone:301-537-4482
Mailing Address - Fax:
Practice Address - Street 1:3504 SILVER PARK DR
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2907
Practice Address - Country:US
Practice Address - Phone:301-755-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MD156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst