Provider Demographics
NPI:1447987540
Name:DYER, JAMES GRAY (MDIV)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GRAY
Last Name:DYER
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1214
Mailing Address - Country:US
Mailing Address - Phone:914-325-6783
Mailing Address - Fax:
Practice Address - Street 1:1419 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5250
Practice Address - Country:US
Practice Address - Phone:914-325-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)