Provider Demographics
NPI:1124532411
Name:GRAY, TIMOTHY E (BCBA, LBA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:E
Last Name:GRAY
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CREAMERY LN
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1499
Mailing Address - Country:US
Mailing Address - Phone:434-518-6559
Mailing Address - Fax:
Practice Address - Street 1:1200 CREAMERY LN
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1499
Practice Address - Country:US
Practice Address - Phone:443-518-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD370103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst