Provider Demographics
NPI:1598841314
Name:MILBOURNE, GREGORY BROUGHTON (PSYD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BROUGHTON
Last Name:MILBOURNE
Suffix:
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:105 RUTGERS AVE UNIT 320
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-2237
Mailing Address - Country:US
Mailing Address - Phone:610-348-7780
Mailing Address - Fax:610-672-9600
Practice Address - Street 1:105 RUTGERS AVE UNIT 320
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-2237
Practice Address - Country:US
Practice Address - Phone:610-348-7780
Practice Address - Fax:610-672-9600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS015613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical