Provider Demographics
NPI:1548652944
Name:GRAY, AMY (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1470
Mailing Address - Country:US
Mailing Address - Phone:413-522-4903
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1470
Practice Address - Country:US
Practice Address - Phone:413-522-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-23
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1185701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical