Provider Demographics
NPI:1528139912
Name:GREGORY, DOUGLAS (LMFT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:GREGORY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MASKEL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1645
Mailing Address - Country:US
Mailing Address - Phone:860-644-6795
Mailing Address - Fax:
Practice Address - Street 1:151 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4584
Practice Address - Country:US
Practice Address - Phone:860-763-8044
Practice Address - Fax:860-272-2990
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist