Provider Demographics
NPI:1508415621
Name:WILLIAMS, GREGORY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:WILLIAMS
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 1:300 JOHN DOWNEY DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2925
Mailing Address - Country:US
Mailing Address - Phone:860-612-2322
Mailing Address - Fax:
Practice Address - Street 1:270 JOHN DOWNEY DR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2906
Practice Address - Country:US
Practice Address - Phone:860-612-2322
Practice Address - Fax:860-612-2301
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001980103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent