Provider Demographics
NPI:1982159422
Name:GREGG-DESAUTELS, CHERYL (LMHC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GREGG-DESAUTELS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BUTTERCUP LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01560-1248
Mailing Address - Country:US
Mailing Address - Phone:774-249-5584
Mailing Address - Fax:
Practice Address - Street 1:208 MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2502
Practice Address - Country:US
Practice Address - Phone:508-478-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health