Provider Demographics
NPI:1609996685
Name:HINRICHSEN, GREGORY ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:HINRICHSEN
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 1:200 W 16TH ST
Mailing Address - Street 2:5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6165
Mailing Address - Country:US
Mailing Address - Phone:212-989-7239
Mailing Address - Fax:
Practice Address - Street 1:200 W 16TH ST
Practice Address - Street 2:5B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6165
Practice Address - Country:US
Practice Address - Phone:212-989-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007772-1103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01350921Medicaid
25588Medicare PIN
NY01350921Medicaid