Provider Demographics
NPI:1346395621
Name:GRAY, LEIGH E (LICSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:LEIGH
Middle Name:E
Last Name:GRAY
Suffix:
Gender:F
Credentials:LICSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHITNEY RD
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2429
Mailing Address - Country:US
Mailing Address - Phone:617-965-0592
Mailing Address - Fax:617-527-0178
Practice Address - Street 1:2 WHITNEY RD
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-2429
Practice Address - Country:US
Practice Address - Phone:617-965-0592
Practice Address - Fax:617-527-0178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW1000871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASW100087OtherSOCIAL WORK LICENSE