1770756934 NPI number — MR. GREGORY JOSEPH HARBILAS LCSW

Table of content: MR. GREGORY JOSEPH HARBILAS LCSW (NPI 1770756934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770756934 NPI number — MR. GREGORY JOSEPH HARBILAS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARBILAS
Provider First Name:
GREGORY
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770756934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
728 POST RD E
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
WESTPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06880-5200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-557-9333
Provider Business Mailing Address Fax Number:
203-557-9332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
728 POST RD E
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
WEST PORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06880-5951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-557-9333
Provider Business Practice Location Address Fax Number:
203-557-9332
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  5729 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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