Provider Demographics
NPI:1215402714
Name:GASTFREUND, DEVORAH
Entity type:Individual
Prefix:
First Name:DEVORAH
Middle Name:
Last Name:GASTFREUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUNE CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4981
Mailing Address - Country:US
Mailing Address - Phone:347-374-0225
Mailing Address - Fax:
Practice Address - Street 1:300 COLONIAL CENTER PKWY STE 100N
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4892
Practice Address - Country:US
Practice Address - Phone:615-200-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty