MEDICARE: DR. GREGORY PETROSKY ED.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6943	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538228838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY PETROSKY ED.D

Provider Business Mailing Address
First Line	:	29 COLLEGE ST
Second Line	:	2ND FLOOR
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-1156
Country	:	US
Telephone Number	:	413-532-3125
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 COLLEGE ST
Second Line	:
City	:	SOUTH HADLEY
State	:	MA
Zip	:	01075-1156
Country	:	US
Telephone Number	:	413-532-3125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	03/31/2015

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