Provider Demographics
NPI:1467965343
Name:GRAY, EMMA L (LSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:L
Other - Last Name:CAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2950 PARKWALK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-1903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10495 MONTGOMERY RD STE 20
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4420
Practice Address - Country:US
Practice Address - Phone:513-862-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker