Provider Demographics
NPI:1013434406
Name:REID, GREGORY (LMHC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:REID
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DEFREEST DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7608
Mailing Address - Country:US
Mailing Address - Phone:518-945-8828
Mailing Address - Fax:
Practice Address - Street 1:120 DEFREEST DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-7608
Practice Address - Country:US
Practice Address - Phone:518-945-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health