Provider Demographics
NPI:1346548351
Name:GREGORY, DEANN ELLEN (MA, CAS)
Entity Type:Individual
Prefix:MS
First Name:DEANN
Middle Name:ELLEN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 IRONA ROAD
Mailing Address - Street 2:
Mailing Address - City:ALTONA
Mailing Address - State:NY
Mailing Address - Zip Code:12910
Mailing Address - Country:US
Mailing Address - Phone:518-594-7546
Mailing Address - Fax:
Practice Address - Street 1:23 HUSKIE LN
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2450
Practice Address - Country:US
Practice Address - Phone:518-483-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY833274981103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool