Provider Demographics
NPI:1144676420
Name:GRAYS-THOMAS, GREGORY T
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:GRAYS-THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-3134
Mailing Address - Fax:857-288-2315
Practice Address - Street 1:774 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3551
Practice Address - Country:US
Practice Address - Phone:617-534-6171
Practice Address - Fax:857-288-2240
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MA2245601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator