Provider Demographics
NPI:1851019996
Name:SORENSON, GREG LOUIS (MA)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:LOUIS
Last Name:SORENSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PARK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1446
Mailing Address - Country:US
Mailing Address - Phone:951-492-9050
Mailing Address - Fax:
Practice Address - Street 1:76 PARK AVE APT 1
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1446
Practice Address - Country:US
Practice Address - Phone:951-492-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health