Provider Demographics
NPI:1346407426
Name:KOVACS, GREGORY ALLEN (MS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALLEN
Last Name:KOVACS
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 1:264 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6209
Mailing Address - Country:US
Mailing Address - Phone:315-527-7936
Mailing Address - Fax:
Practice Address - Street 1:264 RAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:NY
Practice Address - Zip Code:13502-6209
Practice Address - Country:US
Practice Address - Phone:315-527-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-17
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist