Provider Demographics
NPI:1073991725
Name:GREGORY, ERIK (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:GREGORY
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 1:30 JFK ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4902
Mailing Address - Country:US
Mailing Address - Phone:617-645-7871
Mailing Address - Fax:
Practice Address - Street 1:30 JFK ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4902
Practice Address - Country:US
Practice Address - Phone:617-645-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health