Active NPI
Anna Gray, MFT, PSYD.
- Clinical Psychologist
- Petaluma, CA
National Provider Identifier
1891901914
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY31257
- Practice address
- 21 Cherry St
Petaluma, CA 94952-2121 - Phone
- (141) 530-8999
- NPI assigned
- May 15, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC 40052 | CA | |
| Clinical Psychologist | 103TC0700X | PSY31257 | CA | Primary |
Addresses
Primary practice location
21 Cherry St
Petaluma, CA 94952-2121
Mailing address
21 Cherry St
Petaluma, CA 94952-2121
Phone (415) 308-9999
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY31257 | CA | MD | Clinical Psychologist |
| MFC 40052 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651017600000",
"number": "1891901914",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 CHERRY ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522121",
"telephone_number": "415-308-9999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 CHERRY ST",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949522121",
"telephone_number": "141-530-8999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "ANNA",
"credential": "MFT, PSYD.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-15",
"last_updated": "2022-04-27",
"certification_date": "2022-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC 40052",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY31257",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.