Provider Demographics
NPI:1316972565
Name:GRAY, CHRISTINE A (PSY D)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:GRAY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MINOT AVENUE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-333-3308
Mailing Address - Fax:207-333-3309
Practice Address - Street 1:10 MINOT AVENUE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210
Practice Address - Country:US
Practice Address - Phone:207-333-3308
Practice Address - Fax:207-333-3309
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS883103T00000X, 103TB0200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME047399OtherANTHEM
ME431682800Medicaid
ME431682800Medicaid