Provider Demographics
NPI:1700276128
Name:GREGORY, STEPHANIE (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CAYUGA ST
Mailing Address - Street 2:PO 360
Mailing Address - City:UNION SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13160-2403
Mailing Address - Country:US
Mailing Address - Phone:215-514-5060
Mailing Address - Fax:
Practice Address - Street 1:29 FENNELL ST
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-1117
Practice Address - Country:US
Practice Address - Phone:215-514-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP95874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health