Jacqueline Mary Gray, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY11186 Issued in CA

Practice address

5212 Katella Ave
Suite #202
Los Alamitos, CA 90720-2828

Phone

(562) 493-0933

Fax

(562) 493-0922

NPI assigned

Jun 3, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ponciano Wellness, LLC

  • Clinical Psychologist
  • Los Alamitos, CA
  • NPI 1790077543
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520985600000",
    "number": "1124066725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1173",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907201173",
            "telephone_number": "562-493-0933",
            "fax_number": "562-493-0922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5212 KATELLA AVE",
            "address_2": "SUITE #202",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202828",
            "telephone_number": "562-493-0933",
            "fax_number": "562-493-0922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JACQUELINE",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-03",
        "last_updated": "2018-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY11186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER",
            "identifier": "542200PL111861",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dalia Jennifer Gourgy, M.D.
• Grace Counseling Group
• Grace Counseling Group
• Grace Dermatology
• Erin Grasmeyer, MA LMFT
• Franklin Pierce Green, DDS
• George Franklin Green, D.D.S.
• Green, Stuart & Marinow, Harry & Bonfilio, Nicholas & Feiwell, Lawrenc
• Stuart Alan Green, M.D.
• Gretchen a Hetzler MD Incorporated

• Psychologist in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.