Provider Demographics
NPI:1932350279
Name:ENGEL, GREGG (PSYD, LMSW)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:ENGEL
Suffix:
Gender:M
Credentials:PSYD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 N SIDE SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-4901
Mailing Address - Country:US
Mailing Address - Phone:315-363-2451
Mailing Address - Fax:315-363-2451
Practice Address - Street 1:1099 N SIDE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-4901
Practice Address - Country:US
Practice Address - Phone:315-363-2451
Practice Address - Fax:315-363-2451
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0628091041C0700X
NY20021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical