Provider Demographics
NPI:1972647261
Name:BIRCHETT, GREGORY ALLEN (LSCW)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALLEN
Last Name:BIRCHETT
Suffix:
Gender:M
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WILLOW AVE
Mailing Address - Street 2:NYACK
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3515
Mailing Address - Country:US
Mailing Address - Phone:347-612-1929
Mailing Address - Fax:845-323-4920
Practice Address - Street 1:19 WILLOW AVE
Practice Address - Street 2:NYACK
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3515
Practice Address - Country:US
Practice Address - Phone:347-612-1929
Practice Address - Fax:845-323-4920
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0731851101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health