Provider Demographics
NPI:1376633495
Name:GREGORIADES, PAULA
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:GREGORIADES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:GREGORIADES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:700 COLUMBUS AVE
Mailing Address - Street 2:11J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6662
Mailing Address - Country:US
Mailing Address - Phone:212-866-7890
Mailing Address - Fax:
Practice Address - Street 1:3308 30TH AVE
Practice Address - Street 2:2R
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4602
Practice Address - Country:US
Practice Address - Phone:718-932-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026320-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health