Individual
REBECCA FOWLIE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
306 RODMAN RD, AUBURN, ME 04210-3830
(207) 215-0789
Mailing address
22 WARD BROOK RD, WISCASSET, ME 04578-4642
(207) 215-0789
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MC12668
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
435945699
PROVIDER ENROLLMENT
ME
Enumeration date
08/25/2010
Last updated
04/20/2023
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