Provider Demographics
NPI:1447599196
Name:GRAY, CHIKA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHIKA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-6103
Mailing Address - Country:US
Mailing Address - Phone:860-578-9088
Mailing Address - Fax:888-294-8778
Practice Address - Street 1:670 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4240
Practice Address - Country:US
Practice Address - Phone:860-578-9088
Practice Address - Fax:888-294-8778
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical