Provider Demographics
NPI:1508118100
Name:MAGARO, GERALD E (MA)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:MAGARO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 NW LAKESIDE PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1331
Mailing Address - Country:US
Mailing Address - Phone:541-678-8873
Mailing Address - Fax:541-312-5200
Practice Address - Street 1:2098 NW LAKESIDE PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1331
Practice Address - Country:US
Practice Address - Phone:541-678-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25660106H00000X
ORT0797106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1508118100OtherNPI
ORT0797OtherLICENSE