Provider Demographics
NPI:1356587398
Name:CORLEY, GREG
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:CORLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 COLGATE AVE
Mailing Address - Street 2:SUITE 4H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4861
Mailing Address - Country:US
Mailing Address - Phone:917-657-7585
Mailing Address - Fax:
Practice Address - Street 1:10720 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1236
Practice Address - Country:US
Practice Address - Phone:718-651-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker