Provider Demographics
NPI:1487903613
Name:GREGORY, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 OAKLAND BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4395
Mailing Address - Country:US
Mailing Address - Phone:925-301-5591
Mailing Address - Fax:
Practice Address - Street 1:1415 OAKLAND BLVD STE 203
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4395
Practice Address - Country:US
Practice Address - Phone:925-301-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3770103TC1900X, 103TS0200X
FL1843103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling