Provider Demographics
NPI:1154614659
Name:GREGORY, BARRY M (EDD, MED, LMHC,)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:M
Credentials:EDD, MED, LMHC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N. FLORIDA MANGO ROAD
Mailing Address - Street 2:33409
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-637-2156
Mailing Address - Fax:561-637-7433
Practice Address - Street 1:2200 N. FLORIDA MANGO ROAD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-296-5288
Practice Address - Fax:561-297-5287
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH7413OtherFLORIDA MEDICAL LICENSE