Provider Demographics
NPI:1942662150
Name:GILBRIDE, DANIEL J (MA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:GILBRIDE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:JUDE
Other - Last Name:GILBRIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA/MRC, LPC
Mailing Address - Street 1:1330 SW 3RD AVE
Mailing Address - Street 2:APARTMENT 1108
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-6633
Mailing Address - Country:US
Mailing Address - Phone:503-367-3630
Mailing Address - Fax:
Practice Address - Street 1:1330 SW 3RD AVE
Practice Address - Street 2:APARTMENT 1108
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6633
Practice Address - Country:US
Practice Address - Phone:503-367-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-26
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional