MEDICARE: GEOFFREY A GADOW MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor	CC4468	ME
3	101YP2500X	Professional Counselor	PC012350	PA

General Provider Information

NPI Number	:	1740357326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEOFFREY A GADOW MA

Provider Business Mailing Address
First Line	:	113 HICKEY RD
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-8116
Country	:	US
Telephone Number	:	715-314-1032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 S MAIN ST
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-9586
Country	:	US
Telephone Number	:	570-662-7954
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	08/06/2020

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