Healthcare Provider Details

I. General information

NPI: 1154762680
Provider Name (Legal Business Name): KATHERINE GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 OLD MARLBORO RD
CONCORD MA
01742-4775
US

IV. Provider business mailing address

1250 OLD MARLBORO RD
CONCORD MA
01742-4775
US

V. Phone/Fax

Practice location:
  • Phone: 518-330-7664
  • Fax: 518-330-7664
Mailing address:
  • Phone: 518-330-7664
  • Fax: 518-330-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW120877
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: