Provider Demographics
NPI:1124114186
Name:GREGG, DEBORAH JEAN (MA LICENSED PSYCHOLO)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:GREGG
Suffix:
Gender:F
Credentials:MA LICENSED PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10744 ST HWY
Mailing Address - Street 2:EAST SIDE KNOLLS #18
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316-3320
Mailing Address - Country:US
Mailing Address - Phone:814-382-3949
Mailing Address - Fax:814-382-1458
Practice Address - Street 1:10744 ST HWY
Practice Address - Street 2:EAST SIDE KNOLLS #18
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316-3320
Practice Address - Country:US
Practice Address - Phone:814-382-3949
Practice Address - Fax:814-382-1458
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007124L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist