Provider Demographics
NPI:1245478544
Name:LUISE A. GRAY, PSY.D., P.C.
Entity type:Organization
Organization Name:LUISE A. GRAY, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUISE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:856-691-1511
Mailing Address - Street 1:1138 E. CHESTNUT AVE.
Mailing Address - Street 2:BLDG. 6B
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-691-1511
Mailing Address - Fax:856-691-8511
Practice Address - Street 1:1138 E. CHESTNUT AVE.
Practice Address - Street 2:BLDG. 6B
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-691-1511
Practice Address - Fax:856-691-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty