Provider Demographics
NPI:1871059758
Name:HENRIQUES, GREGG ROS (PHD)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:ROS
Last Name:HENRIQUES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 JOHNSTON HALL MSC 7401 JAMES MADISON UNIVERSITY
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22807-0001
Mailing Address - Country:US
Mailing Address - Phone:540-568-7857
Mailing Address - Fax:
Practice Address - Street 1:755 MARTIN LUTHER KING JR WAY # 9012
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3257
Practice Address - Country:US
Practice Address - Phone:540-568-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical