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MR. GARY FEDOROFF
NPI 1093036717
Counselor - Addiction (Substance Use Disorder) in San Rafael, CA

Active since June 16, 2010
171 CARLOS DR, SAN RAFAEL, CA 94903(415) 755-2310(415) 755-2210 Get Directions Write a Review

NPPES record last updated: June 16, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Gary Fedoroff NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. GARY FEDOROFF (NPI 1093036717) is an individual addiction (substance use disorder) provider in San Rafael, California and active in the NPI registry since June 2010.

NPPES Registry Identity

NPI1093036717
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameMR. GARY FEDOROFF
Location Address171 CARLOS DRSan Rafael, CA 94903-2005
Mailing Address171 Carlos DrSan Rafael, CA 94903-2005 · (415) 755-2310 · Fax (415) 755-2210
Phone(415) 755-2310
Fax(415) 755-2210
Sole ProprietorNo
Enumeration DateJune 16, 2010
✔ NPI 1093036717 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
171 CARLOS DR, San Rafael, CA 94903
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Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. ANNELI KIM RICHARDS MS
Counselor (Mental Health)
171 CARLOS DR, BAY AREA COMMUNITY RESOURCES
SAN RAFAEL, CA 94903
Marin County (415) 444-5580
MRS. CARIN GROVE MA, MFT
Counselor (Mental Health)
171 CARLOS DR
SAN RAFAEL, CA 94903
Marin County (415) 444-5580
WENDY ALVAREZ
Counselor (Addiction (Substance Use Disorder))
171 CARLOS DR
SAN RAFAEL, CA 94903
Marin County (415) 755-2310
MICHAEL COLEMAN CADCII CCJP
Counselor (Addiction (Substance Use Disorder))
171 CARLOS DR
SAN RAFAEL, CA 94903
Marin County (415) 444-5580
SUSAN POLLACK LCSW
Social Worker
171 CARLOS DR
SAN RAFAEL, CA 94903
Marin County (415) 755-2385
CHAU TRAN MSW, 2009
Social Worker (School)
171 CARLOS DR
SAN RAFAEL, CA 94903
Marin County (415) 444-5580
LAURA KANTOROWSKI
Psychologist (Counseling)
171 CARLOS DR
SAN RAFAEL, CA 94903
Marin County (415) 755-2328
MS. TIARRE DIANA WELSH MS., MFTI
Marriage & Family Therapist
171 CARLOS DR
SAN RAFAEL, CA 94903
Marin County (415) 444-5580

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gary Fedoroff's NPI number?

The NPI number for Gary Fedoroff is 1093036717. It was assigned to this individual provider in the NPPES registry on June 16, 2010.

Where is Gary Fedoroff located?

Gary Fedoroff practices at 171 Carlos Dr, San Rafael, CA 94903. The listed phone number is (415) 755-2310.

What is Gary Fedoroff's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Gary Fedoroff was last updated on June 16, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.