Provider Demographics
NPI:1477993178
Name:DIGIACOMO, GREGORY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:DIGIACOMO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ABBOT RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2322
Mailing Address - Country:US
Mailing Address - Phone:631-793-9156
Mailing Address - Fax:
Practice Address - Street 1:29 ABBOT RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2322
Practice Address - Country:US
Practice Address - Phone:631-793-9156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021801103T00000X
WAPY60632239103T00000X
NY749032131103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist