Provider Demographics
NPI:1225653116
Name:ZELTT, GREGORY CHARLES
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CHARLES
Last Name:ZELTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WASHINGTON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4764
Mailing Address - Country:US
Mailing Address - Phone:617-639-4671
Mailing Address - Fax:781-817-6745
Practice Address - Street 1:400 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4729
Practice Address - Country:US
Practice Address - Phone:617-639-4671
Practice Address - Fax:781-817-6745
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health