Provider Demographics
NPI:1770913949
Name:ERN, GREGORY (PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:ERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 58TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-4608
Mailing Address - Country:US
Mailing Address - Phone:772-444-6455
Mailing Address - Fax:
Practice Address - Street 1:1940 58TH AVE STE D
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-4608
Practice Address - Country:US
Practice Address - Phone:772-444-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS673103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool