Provider Demographics
NPI:1316630593
Name:MCCRAY, KATHLEEN E
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 DIX ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6965
Mailing Address - Country:US
Mailing Address - Phone:202-547-3870
Mailing Address - Fax:202-399-0849
Practice Address - Street 1:5820 DIX ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6965
Practice Address - Country:US
Practice Address - Phone:202-547-3870
Practice Address - Fax:202-399-0849
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)