Provider Demographics
NPI:1710446398
Name:PAQUIN, GREGORY J (PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:PAQUIN
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 1:2 REGENCY PLZ STE 12
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3143
Mailing Address - Country:US
Mailing Address - Phone:401-421-1405
Mailing Address - Fax:
Practice Address - Street 1:2 REGENCY PLZ STE 12
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3143
Practice Address - Country:US
Practice Address - Phone:401-421-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPSO1759103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist