Provider Demographics
NPI:1629426390
Name:PAMPHILE, GREGORY
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:PAMPHILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-6003
Mailing Address - Country:US
Mailing Address - Phone:774-240-6827
Mailing Address - Fax:617-829-9596
Practice Address - Street 1:532 PAGE ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-6003
Practice Address - Country:US
Practice Address - Phone:774-240-6827
Practice Address - Fax:617-829-9596
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001214691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical