Provider Demographics
NPI:1740357326
Name:GADOW, GEOFFREY A (MA)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:A
Last Name:GADOW
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HICKEY RD
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-8116
Mailing Address - Country:US
Mailing Address - Phone:715-314-1032
Mailing Address - Fax:
Practice Address - Street 1:1550 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-9586
Practice Address - Country:US
Practice Address - Phone:570-662-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MECC4468101YP2500X
PAPC012350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor