Provider Demographics
NPI:1275644437
Name:GREGORY, DONALD A (MS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:A
Last Name:GREGORY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 FALLBROOK ST
Mailing Address - Street 2:PO BOX 514
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-0514
Mailing Address - Country:US
Mailing Address - Phone:570-282-1732
Mailing Address - Fax:570-282-6529
Practice Address - Street 1:185 FALLBROOK ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-0514
Practice Address - Country:US
Practice Address - Phone:570-282-1732
Practice Address - Fax:570-282-6529
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007908L103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical