Provider Demographics
NPI:1598991812
Name:MACGRAY, LISA ANN (CMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:MACGRAY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 INDIAN SPRING TRL
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2015
Mailing Address - Country:US
Mailing Address - Phone:973-879-1106
Mailing Address - Fax:
Practice Address - Street 1:100 MADISON AVE., FLOOR C
Practice Address - Street 2:CHANGING LIFESTYLES
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07962
Practice Address - Country:US
Practice Address - Phone:973-971-6301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00134300171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor