Provider Demographics
NPI:1962468694
Name:GREGORY, ROBERT JAMES (ED D, LPC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:GREGORY
Suffix:
Gender:M
Credentials:ED D, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-0472
Mailing Address - Country:US
Mailing Address - Phone:724-845-9880
Mailing Address - Fax:
Practice Address - Street 1:913 TALON CT
Practice Address - Street 2:SUITE 7
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-9509
Practice Address - Country:US
Practice Address - Phone:724-845-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003332101YP2500X
PAPS016983103TC1900X, 103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA480287Medicaid