Provider Demographics
NPI:1841574340
Name:DEBENEDICTIS, GABRIEL
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:DEBENEDICTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 NW EVERGREEN PKWY APT 350
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7052
Mailing Address - Country:US
Mailing Address - Phone:503-268-7859
Mailing Address - Fax:
Practice Address - Street 1:117 N 29TH AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:OR
Practice Address - Zip Code:97113-8517
Practice Address - Country:US
Practice Address - Phone:503-597-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor