Provider Demographics
NPI:1073922332
Name:GREGORY, COLETTE SIMONE (MED/MA)
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:SIMONE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MED/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 MIDDLEFIELD RD
Mailing Address - Street 2:APT. 310
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2512
Mailing Address - Country:US
Mailing Address - Phone:219-218-5563
Mailing Address - Fax:
Practice Address - Street 1:237 RACE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4823
Practice Address - Country:US
Practice Address - Phone:408-510-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator