Provider Demographics
NPI:1609170083
Name:GREGOR, KRISTIN LORRAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:LORRAINE
Last Name:GREGOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BRIDLE PATH
Mailing Address - Street 2:
Mailing Address - City:SHERBORN
Mailing Address - State:MA
Mailing Address - Zip Code:01770-1490
Mailing Address - Country:US
Mailing Address - Phone:802-734-1446
Mailing Address - Fax:
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:857-203-5529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9847103TC0700X, 261QV0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No103T00000XBehavioral Health & Social Service ProvidersPsychologist