Provider Demographics
NPI:1780702985
Name:KAY, GARY GLEN (PHD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:GLEN
Last Name:KAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 MASSACHUSETTS AVE NW
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4358
Mailing Address - Country:US
Mailing Address - Phone:202-686-7520
Mailing Address - Fax:
Practice Address - Street 1:4900 MASSACHUSETTS AVE NW
Practice Address - Street 2:SUITE 240
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4358
Practice Address - Country:US
Practice Address - Phone:202-686-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1384103G00000X
MD2075103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist