Provider Demographics
NPI:1619080900
Name:GUARDALABENE, JEFF (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:GUARDALABENE
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 NE FREMONT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4437
Mailing Address - Country:US
Mailing Address - Phone:503-281-7888
Mailing Address - Fax:503-281-8646
Practice Address - Street 1:6221 NE FREMONT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4437
Practice Address - Country:US
Practice Address - Phone:503-281-7888
Practice Address - Fax:503-281-8646
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR299505OtherOMAP