Active NPI
Patricia A Gray, MSSA, LSW
- Clinical Social Worker
- Canton, OH
National Provider Identifier
1396961090
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jun 18, 2009.
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- S0029437
- Practice address
- 919 2ND St NE
Canton, OH 44704-1132 - Phone
- (330) 454-7917
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | S0029437 | OH | Primary |
Addresses
Primary practice location
919 2ND St NE
Canton, OH 44704-1132
Mailing address
1787 Beechwood Ave NE
North Canton, OH 44720-8610
Phone (330) 305-0335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S0029437 | OH | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396961090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1787 BEECHWOOD AVE NE",
"city": "NORTH CANTON",
"state": "OH",
"postal_code": "447208610",
"telephone_number": "330-305-0335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "919 2ND ST NE",
"city": "CANTON",
"state": "OH",
"postal_code": "447041132",
"telephone_number": "330-454-7917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "PATRICIA",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "MSSA, LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "S0029437",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.