Individual provider Active NPI

Deborah A Gray, LCSW, LADC, CCS

  • Clinical Social Worker
  • Presque Isle, ME
National Provider Identifier
1215955307
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC6879 Issued in ME
Practice address
147 Academy St
Presque Isle, ME 04769
Phone
(207) 764-6825
Fax
(207) 764-6077
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LC1689 ME
Clinical Social Worker 1041C0700X CCS2869 ME
Clinical Social Worker 1041C0700X LC6879 ME Primary

Addresses

Primary practice location

147 Academy St
Presque Isle, ME 04769

Mailing address

PO Box 509
Presque Isle, ME 04769-0509
Phone (207) 764-6825

Other practice location 1

37 Bangor St Ste 8
Houlton, ME 04730-1739
Phone (207) 532-9660 ext. 10

Other practice location 2

37 Bangor St Ste 8
Houlton, ME 04730-1739
Phone (207) 532-9660 ext. 10

Other identifiers 1

IdentifierTypeStateIssuer
1215955307MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040227000369 ME Practitioner - Clinical Social Worker 9638065352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Life by Design, PAGroup PAC ID 9032188909, 6 clinicians

Practice addresses (Care Compare)

147 Academy St
Presque Isle, ME 04769-3101
Phone (207) 764-6825

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CCS2869MEMDClinical Social Worker
LC6879MEMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Life by Design, PA Clinical CurrentSince Jul 1, 2003 Accepting new patients
Micmac Health Department PastSince Dec 22, 2019 Accepting new patients
Life by Design PastSince Oct 6, 2019 Accepting new patients
Carlos G. Otis Health Care Center Inc. PastSince Feb 1, 2004 Accepting new patients

Locations

37 Bangor St
Ste 8
Houlton, ME 04730
Phone (207) 532-9660

18 High St
Houlton, ME 04730
Phone (207) 532-9660

147 Academy St
Presque Isle, ME 04769
Phone (207) 532-9660

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1215955307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 509",
            "city": "PRESQUE ISLE",
            "state": "ME",
            "postal_code": "047690509",
            "telephone_number": "207-764-6825",
            "fax_number": "207-764-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 ACADEMY ST",
            "city": "PRESQUE ISLE",
            "state": "ME",
            "postal_code": "04769",
            "telephone_number": "207-764-6825",
            "fax_number": "207-764-6077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "37 Bangor St Ste 8",
            "address_purpose": "LOCATION",
            "city": "Houlton",
            "state": "ME",
            "postal_code": "047301739",
            "country_code": "US",
            "telephone_number": "207-532-9660 x10",
            "fax_number": "207-532-9640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "37 Bangor St Ste 8",
            "address_purpose": "LOCATION",
            "city": "Houlton",
            "state": "ME",
            "postal_code": "047301739",
            "country_code": "US",
            "telephone_number": "207-532-9660 x10",
            "fax_number": "207-532-9640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "DEBORAH",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "LCSW, LADC, CCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC1689",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "CCS2869",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC6879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215955307",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Presque Isle, ME

Sources for this page

Verify at the official NPI Registry.