Provider Demographics
NPI:1902223407
Name:GRAY, GAIL SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:SUSAN
Last Name:GRAY
Suffix:
Gender:F
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:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-0303
Mailing Address - Country:US
Mailing Address - Phone:607-760-5443
Mailing Address - Fax:
Practice Address - Street 1:1115 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-9603
Practice Address - Country:US
Practice Address - Phone:607-760-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006626-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist