Provider Demographics
NPI:1861564759
Name:CARON, GREGORY RALPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RALPH
Last Name:CARON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-1256
Mailing Address - Country:US
Mailing Address - Phone:757-465-2155
Mailing Address - Fax:
Practice Address - Street 1:USS DWIGHT D. EISENHOWER CVN 69
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09534 2830
Practice Address - Country:US
Practice Address - Phone:757-445-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03339103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical