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General NPI Number Information
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NPI Number | 1124385604
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Entity Type | Individual
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Provider Name | ADAM BARRETT GRAY L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 4003 N BROADWAY ST 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60613
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Country | US
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Telephone | 773-828-9449
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Fax | 773-834-8088
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Provider Business Mailing Address
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Address Line | 625 W PATTERSON AVE APT 1E
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City | CHICAGO
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State | IL
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Zip | 60613-4471
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Country | US
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Telephone | 734-834-0627
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Fax | 773-834-8088
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076536-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 65721
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149012560
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License Number State | IL
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