Provider Demographics
NPI:1568973592
Name:GRAY, ANDREADENISE JACQUELINE (RBT)
Entity type:Individual
Prefix:
First Name:ANDREADENISE
Middle Name:JACQUELINE
Last Name:GRAY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MADISON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3269
Mailing Address - Country:US
Mailing Address - Phone:914-843-5740
Mailing Address - Fax:
Practice Address - Street 1:11420 DAIRY ASHFORD RD STE 108
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-6215
Practice Address - Country:US
Practice Address - Phone:832-500-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician