Provider Demographics
NPI:1275058737
Name:GREGORY, PAULINE BECTON (EDS, MS)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:BECTON
Last Name:GREGORY
Suffix:
Gender:F
Credentials:EDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83296 PURPLE MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-2627
Mailing Address - Country:US
Mailing Address - Phone:904-708-9427
Mailing Address - Fax:
Practice Address - Street 1:1903 ISLAND WALK WAY
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4797
Practice Address - Country:US
Practice Address - Phone:904-277-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool