Provider Demographics
NPI:1013064278
Name:GRAY, BARBARA RUTH (MSW,LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:RUTH
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-8814
Mailing Address - Country:US
Mailing Address - Phone:508-879-7983
Mailing Address - Fax:508-626-8422
Practice Address - Street 1:5 EDGELL RD
Practice Address - Street 2:SUITE 27
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4874
Practice Address - Country:US
Practice Address - Phone:508-879-7983
Practice Address - Fax:508-626-8422
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021847101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGRP22497Medicare ID - Type Unspecified