Provider Demographics
NPI:1972724912
Name:GAFFGA-MADRESH, PATRICIA A (EDS, LMFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:GAFFGA-MADRESH
Suffix:
Gender:F
Credentials:EDS, LMFT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:GAFFGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDS, LMFT
Mailing Address - Street 1:230 HARBOR INN ROAD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-3614
Mailing Address - Country:US
Mailing Address - Phone:732-269-1345
Mailing Address - Fax:
Practice Address - Street 1:620 LACEY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2244
Practice Address - Country:US
Practice Address - Phone:732-269-1345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00135300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist