Provider Demographics
NPI:1982134227
Name:MCRAE, GARY ALAN (MSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
Last Name:MCRAE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62226 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-9438
Mailing Address - Country:US
Mailing Address - Phone:574-875-5117
Mailing Address - Fax:
Practice Address - Street 1:62226 COUNTY ROAD 15
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-9438
Practice Address - Country:US
Practice Address - Phone:574-875-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty