Provider Demographics
NPI:1962954958
Name:WARE, GREGOIRE LEIGH
Entity type:Individual
Prefix:
First Name:GREGOIRE
Middle Name:LEIGH
Last Name:WARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1217
Mailing Address - Country:US
Mailing Address - Phone:212-633-0815
Mailing Address - Fax:845-633-5768
Practice Address - Street 1:2006 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1217
Practice Address - Country:US
Practice Address - Phone:212-633-0815
Practice Address - Fax:845-633-5768
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP04119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist