Jacqueline Gray, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801097979 Issued in MI

Practice address

100 NB Gratiot Ave
Mount Clemens, MI 48043-2301

Phone

(586) 783-2950

Fax

(586) 690-4333

NPI assigned

Jun 17, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1235510017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NB GRATIOT AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432301",
            "telephone_number": "586-690-4333",
            "fax_number": "586-783-2950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NB GRATIOT AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432301",
            "telephone_number": "586-783-2950",
            "fax_number": "586-690-4333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79 W Alexandrine St",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482012015",
            "country_code": "US",
            "telephone_number": "313-831-5535",
            "fax_number": "313-831-2608",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JACQUELINE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801097979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Goodin, FNP
• Lyndon M Graham, CRNA
• Nakya Kai Graham
• Thomas C Gratch
• Evan Robert Papa Gray
• Hollie A Green, AGAC-NP-BC
• April Claire Gregoire
• Steven Douglas Grejda, D.O.
• Kelley Grice, B.S
• Georgia Griffin, D.O.

• All providers in Mount Clemens, MI
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.