Provider Demographics
NPI:1275968778
Name:GREY, ELIZABETH CATHERINE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CATHERINE
Last Name:GREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CATHERINE
Other - Last Name:REALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:155 MAPLE ST STE 304
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1828
Mailing Address - Country:US
Mailing Address - Phone:857-320-1299
Mailing Address - Fax:413-301-6173
Practice Address - Street 1:155 MAPLE ST STE 304
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105
Practice Address - Country:US
Practice Address - Phone:857-320-1299
Practice Address - Fax:413-301-6173
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2218371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical