Provider Demographics
NPI:1467280198
Name:GREGORY, KATELYN ELIZABETH (LMSW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6181 DOUGLAS CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-1168
Mailing Address - Country:US
Mailing Address - Phone:315-521-3159
Mailing Address - Fax:
Practice Address - Street 1:6539 ANTHONY DR STE A
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1441
Practice Address - Country:US
Practice Address - Phone:585-398-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0950221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical