Provider Demographics
NPI:1538454350
Name:GRAY-JOSEPH, DORNA
Entity type:Individual
Prefix:
First Name:DORNA
Middle Name:
Last Name:GRAY-JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64A GLENWAY ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-4021
Mailing Address - Country:US
Mailing Address - Phone:617-602-5800
Mailing Address - Fax:
Practice Address - Street 1:434 WARREN ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1325
Practice Address - Country:US
Practice Address - Phone:617-541-6859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker