Provider Demographics
NPI:1972766848
Name:GRAY, CAROLYNN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYNN
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:CAROLYNN
Other - Middle Name:MARIE
Other - Last Name:LANGSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20253 REDWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4331
Mailing Address - Country:US
Mailing Address - Phone:510-224-3624
Mailing Address - Fax:
Practice Address - Street 1:20253 REDWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4331
Practice Address - Country:US
Practice Address - Phone:510-224-3624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26218103T00000X, 103TF0000X, 103TC0700X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program