Provider Demographics
NPI:1124385604
Name:GRAY, ADAM BARRETT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:BARRETT
Last Name:GRAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:625 W PATTERSON AVE
Mailing Address - Street 2:APT 1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4471
Mailing Address - Country:US
Mailing Address - Phone:734-834-0627
Mailing Address - Fax:773-834-8088
Practice Address - Street 1:4003 N BROADWAY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613
Practice Address - Country:US
Practice Address - Phone:773-828-9449
Practice Address - Fax:773-834-8088
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076536-11041C0700X
CA657211041C0700X
IL1490125601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical