Provider Demographics
NPI:1346912136
Name:GRAY, LISA (BA, MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:BA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CEDARWOOD DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6801
Mailing Address - Country:US
Mailing Address - Phone:603-802-6603
Mailing Address - Fax:
Practice Address - Street 1:9 CEDARWOOD DR UNIT 6
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6801
Practice Address - Country:US
Practice Address - Phone:603-802-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker