Provider Demographics
NPI:1992812770
Name:WARD-GRAY, LYDIA S (PSYD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:S
Last Name:WARD-GRAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:S
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 10187
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-5187
Mailing Address - Country:US
Mailing Address - Phone:207-777-4111
Mailing Address - Fax:207-783-6660
Practice Address - Street 1:33 MOLLISON WAY
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5805
Practice Address - Country:US
Practice Address - Phone:207-755-3785
Practice Address - Fax:207-376-3080
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS881103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME233310199Medicaid
ME233310199Medicaid
MER18012Medicare UPIN