Provider Demographics
NPI:1932615374
Name:GRAY, LORRAINE E (LSW)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:E
Last Name:GRAY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7162 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-3838
Mailing Address - Country:US
Mailing Address - Phone:513-961-5900
Mailing Address - Fax:513-961-5903
Practice Address - Street 1:2627 PARK AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1476
Practice Address - Country:US
Practice Address - Phone:513-363-1900
Practice Address - Fax:513-484-3422
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1100515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH104100000XMedicaid