Provider Demographics
NPI:1336877026
Name:PAFITIS, GINA (CASAC T)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:PAFITIS
Suffix:
Gender:F
Credentials:CASAC T
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASAC T
Mailing Address - Street 1:151 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1926
Mailing Address - Country:US
Mailing Address - Phone:631-317-0963
Mailing Address - Fax:
Practice Address - Street 1:151 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1926
Practice Address - Country:US
Practice Address - Phone:631-317-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37547101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)