Provider Demographics
NPI:1295848745
Name:GRAYSON, ELLEN S (MSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:S
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LINCOLN TRL
Mailing Address - Street 2:
Mailing Address - City:HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07843-1548
Mailing Address - Country:US
Mailing Address - Phone:973-879-9211
Mailing Address - Fax:973-292-3385
Practice Address - Street 1:43 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7508
Practice Address - Country:US
Practice Address - Phone:973-879-9211
Practice Address - Fax:973-292-3385
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000309001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical