Provider Demographics
NPI:1952384158
Name:GRAY, JUDITH ANNE (APRN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25485 HARCUM WHARF RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:MD
Mailing Address - Zip Code:21822-2167
Mailing Address - Country:US
Mailing Address - Phone:443-880-2995
Mailing Address - Fax:817-877-7197
Practice Address - Street 1:25485 HARCUM WHARF RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:MD
Practice Address - Zip Code:21822-2167
Practice Address - Country:US
Practice Address - Phone:443-880-2995
Practice Address - Fax:877-817-7197
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR039465101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD136851000OtherMAGELLAN
MDPB64960OtherAPS
MD425142OtherMAMSI
DCK2890001OtherCAREFIRST BLUE CROSS BLUE
MD563BJAOtherCAREFIRST BCBS
MDPB64960OtherAPS