Provider Demographics
NPI:1184753741
Name:GRAY, NANCY MEADE (MED, LMFT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MEADE
Last Name:GRAY
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 SAN MATEO DR
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-5637
Mailing Address - Country:US
Mailing Address - Phone:650-473-9242
Mailing Address - Fax:650-473-9245
Practice Address - Street 1:1111 TRITON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1286
Practice Address - Country:US
Practice Address - Phone:650-358-9926
Practice Address - Fax:650-473-9245
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist