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Individual
MS. LISA M GRAY
Active
Individual
MS. LISA M GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-004635
IL
1041C0700X
Clinical Social Worker
149.004635
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02204610
BCBS PROVIDER #
IL
Enumeration date
08/04/2006
Last updated
06/18/2025
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