Provider Demographics
NPI:1750525861
Name:LOOMAS, GARY LOWELL (LCSW)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LOWELL
Last Name:LOOMAS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1723
Mailing Address - Country:US
Mailing Address - Phone:503-283-1950
Mailing Address - Fax:
Practice Address - Street 1:6202 N BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4110
Practice Address - Country:US
Practice Address - Phone:503-283-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLO6291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11949699OtherCAQH
L629SROtherSTATE LICENSE
ORR146956Medicare PIN