Provider Demographics
NPI:1023199114
Name:KORGESKI, GREGORY PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:KORGESKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:SAXTONS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05154-0408
Mailing Address - Country:US
Mailing Address - Phone:802-869-1120
Mailing Address - Fax:
Practice Address - Street 1:559 LEACH RD
Practice Address - Street 2:
Practice Address - City:SAXTONS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05154-9707
Practice Address - Country:US
Practice Address - Phone:802-869-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0820103T00000X
VT048.0046743103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist