Healthcare Provider Details

I. General information

NPI: 1174935449
Provider Name (Legal Business Name): LORRAINE K GREGG M.ED, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 04/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 PEARL ST STE 3&3B
STOUGHTON MA
02072-1610
US

IV. Provider business mailing address

964 PARKER ST
JAMAICA PLAIN MA
02130-1553
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-0057
  • Fax: 781-344-0027
Mailing address:
  • Phone: 617-690-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: