Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003061953 |
---|---|
Provider Name | Kimberly Ann Gray |
First Address | St Petersburg, FL 33701-4816 |
Second Address | St Petersburg, FL 33701-4820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2008 |
Last Update Date | 19/11/2008 |