Provider Demographics
NPI:1265825202
Name:GRAD, CORY JAMES (LCSW)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:JAMES
Last Name:GRAD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 BURLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1516
Mailing Address - Country:US
Mailing Address - Phone:708-995-3680
Mailing Address - Fax:
Practice Address - Street 1:1023 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1516
Practice Address - Country:US
Practice Address - Phone:708-995-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0247661041C0700X
IL385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No385H00000XRespite Care FacilityRespite Care