Provider Demographics
NPI:1669786554
Name:GREGOR, COURTNEY ANNE (LMSW)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:ANNE
Last Name:GREGOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 2ND AVE
Mailing Address - Street 2:APT. 18B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9154
Mailing Address - Country:US
Mailing Address - Phone:516-729-8372
Mailing Address - Fax:
Practice Address - Street 1:484 2ND AVE
Practice Address - Street 2:APT. 18B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9154
Practice Address - Country:US
Practice Address - Phone:516-729-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079214282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital