Provider Demographics
NPI:1407064462
Name:JANOLYN GREGG PHD PA
Entity Type:Organization
Organization Name:JANOLYN GREGG PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD PA
Authorized Official - Phone:954-385-0353
Mailing Address - Street 1:1625 N COMMERCE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3216
Mailing Address - Country:US
Mailing Address - Phone:954-385-0353
Mailing Address - Fax:954-389-0886
Practice Address - Street 1:1625 N COMMERCE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3216
Practice Address - Country:US
Practice Address - Phone:954-385-0353
Practice Address - Fax:954-389-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4483103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1470912363Medicare PIN