Provider Demographics
NPI:1942525548
Name:VAN DAM, GREGORY ALAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:VAN DAM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 LEE RD
Mailing Address - Street 2:STE 290
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7202
Mailing Address - Country:US
Mailing Address - Phone:561-252-7336
Mailing Address - Fax:
Practice Address - Street 1:1936 LEE RD
Practice Address - Street 2:STE 290
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7202
Practice Address - Country:US
Practice Address - Phone:407-233-1864
Practice Address - Fax:407-563-3264
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical