Provider Demographics
NPI:1447661574
Name:GRAY, JOANNA (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:MAEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:300 GARDEN CITY PLZ
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3302
Mailing Address - Country:US
Mailing Address - Phone:516-747-9030
Mailing Address - Fax:
Practice Address - Street 1:300 GARDEN CITY PLZ
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3302
Practice Address - Country:US
Practice Address - Phone:516-747-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1080098174400000X
1-14-16001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist