Provider Demographics
NPI:1407924327
Name:GRAY, ELIZABETH LYNN (LICSW, LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
Last Name:GRAY
Suffix:
Gender:F
Credentials:LICSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 A REID STREET
Mailing Address - Street 2:MADIGAN HEALTH SYSTEM/ ARMY SUBSTANCE ABUSE PROGRAM
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9040 A REID STREET
Practice Address - Street 2:MADIGAN HEALTH SYSTEM/ ARMY SUBSTANCE ABUSE PROGRAM
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-967-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5785104100000X
RIISW021271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical