Healthcare Provider Details

I. General information

NPI: 1487903613
Provider Name (Legal Business Name): MARIA GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 CAMINO DIABLO STE 210
WALNUT CREEK CA
94597-3953
US

IV. Provider business mailing address

2910 CAMINO DIABLO STE 210
WALNUT CREEK CA
94597-3953
US

V. Phone/Fax

Practice location:
  • Phone: 925-301-5591
  • Fax:
Mailing address:
  • Phone: 925-301-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3770
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3770
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: