Provider Demographics
NPI:1487705919
Name:GRAZIAN, GAIL E (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:E
Last Name:GRAZIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 W TOUHY AVE
Mailing Address - Street 2:302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2645
Mailing Address - Country:US
Mailing Address - Phone:773-256-1948
Mailing Address - Fax:
Practice Address - Street 1:1340 W TOUHY AVE
Practice Address - Street 2:302
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2645
Practice Address - Country:US
Practice Address - Phone:773-256-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490035741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL549680Medicare ID - Type Unspecified