Provider Demographics
NPI:1386955227
Name:GRAY, SUZANNE S (MM,MED)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:S
Last Name:GRAY
Suffix:
Gender:F
Credentials:MM,MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1218
Mailing Address - Country:US
Mailing Address - Phone:978-922-8464
Mailing Address - Fax:
Practice Address - Street 1:149 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3564
Practice Address - Country:US
Practice Address - Phone:978-774-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA341252252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency