Provider Demographics
NPI:1144500752
Name:SPADAFORA, GARY GREGERY (MA)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:GREGERY
Last Name:SPADAFORA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:247 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4169
Mailing Address - Country:US
Mailing Address - Phone:503-869-6417
Mailing Address - Fax:503-408-5010
Practice Address - Street 1:247 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4169
Practice Address - Country:US
Practice Address - Phone:503-869-6417
Practice Address - Fax:503-408-5010
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health