Provider Demographics
NPI:1265238281
Name:DERAS, GABRIELLA
Entity type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:
Last Name:DERAS
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:GABY
Other - Middle Name:
Other - Last Name:DERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7026 NORTH BURLINGTON AVE
Mailing Address - Street 2:7026
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203
Mailing Address - Country:US
Mailing Address - Phone:818-415-2621
Mailing Address - Fax:
Practice Address - Street 1:324 NW DAVIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3925
Practice Address - Country:US
Practice Address - Phone:503-226-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)