Provider Demographics
NPI:1003467861
Name:ADELSTEIN, GREGORY REID (PSYD, LMHC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:REID
Last Name:ADELSTEIN
Suffix:
Gender:M
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 OTTAWA LN
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4616
Mailing Address - Country:US
Mailing Address - Phone:703-967-9945
Mailing Address - Fax:
Practice Address - Street 1:3418 OTTAWA LN
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-4616
Practice Address - Country:US
Practice Address - Phone:754-216-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty