Latrice Kiane Gray, MSW, LCSW-C, RPT

Primary specialty

Social WorkerTaxonomy code 104100000X

License

18674 Issued in MD

Practice address

5304 Cedar Dr
Cambridge, MD 21613-4404

Phone

(410) 929-7427

NPI assigned

Jul 24, 2017

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

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Creative Space Child Therapy, LLC.

  • Clinical Social Worker
  • Cambridge, MD
  • NPI 1255085056
  NPD Authorized official

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

{
    "created_epoch": "1500854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1780107524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5304 CEDAR DR",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216134404",
            "telephone_number": "410-929-7427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5304 CEDAR DR",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216134404",
            "telephone_number": "410-929-7427"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 Eastern Shore Dr",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218045934",
            "country_code": "US",
            "telephone_number": "844-224-5264",
            "fax_number": "844-224-5264",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "LATRICE",
        "middle_name": "KIANE",
        "credential": "MSW, LCSW-C, RPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-24",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "18674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND BOARD OF SOCIAL WORK",
            "identifier": "18674",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy David Gladwell, PHARM.D.
• Jennifer Goddard Brant, PA-C
• Brittany Gowe, CRNP
• Gratitude Behavioral Health LLC
• Pamela Graves
• Stacy Lynn Green
• Katherine Griffin, NP
• Anna Zito Hackney
• Ashley Hall, MS, CAC-AD
• Vicki Ann Hardisty, APRN, CNP

• Social Worker in Cambridge, MD
• Providers in Cambridge, MD by specialty
• Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2020; 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.