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General NPI Number Information
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NPI Number | 1528433406
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Entity Type | Individual
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Provider Name | LUCIANE L GRAY LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 555 WILLARD AVE 2C-1145
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City | NEWINGTON
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State | CT
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Zip | 06111-2631
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Country | US
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Telephone | 860-212-0010
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Fax |
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Provider Business Mailing Address
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Address Line | 69 PARTRIDGE LN
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City | TOLLAND
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State | CT
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Zip | 06084-3807
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Country | US
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Telephone | 860-841-1987
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 002858
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License Number State | CT
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