Provider Demographics
NPI:1700800612
Name:GRAY, JEANNE HULL (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:HULL
Last Name:GRAY
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 OLD SHERMAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-4003
Mailing Address - Country:US
Mailing Address - Phone:203-266-4712
Mailing Address - Fax:
Practice Address - Street 1:423 OLD SHERMAN HILL RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-4003
Practice Address - Country:US
Practice Address - Phone:203-266-4712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000134101YA0400X
CT000383106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist