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General NPI Number Information
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NPI Number | 1831107002
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Entity Type | Individual
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Provider Name | LISA M GRAY LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1300 IROQUOIS AVE STE 145
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City | NAPERVILLE
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State | IL
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Zip | 60563-1389
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Country | US
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Telephone | 630-305-0464
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Fax | 630-305-0211
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Provider Business Mailing Address
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Address Line | 1300 IROQUOIS AVE STE 145
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City | NAPERVILLE
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State | IL
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Zip | 60563-1389
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Country | US
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Telephone | 630-305-0464
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Fax | 630-305-0211
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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 | 149.004635
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License Number State | IL
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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 | 149-004635
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License Number State | IL
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