Provider Demographics
NPI:1154555399
Name:LOWDER, GREGORY M (PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:LOWDER
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 1:1619 3RD AVE
Mailing Address - Street 2:(SUITE #3)
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3459
Mailing Address - Country:US
Mailing Address - Phone:212-249-5849
Mailing Address - Fax:
Practice Address - Street 1:1619 3RD AVE
Practice Address - Street 2:(SUITE #3)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3459
Practice Address - Country:US
Practice Address - Phone:212-249-5849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical