Provider Demographics
NPI:1871275032
Name:GAFFNEY, MICHAELA (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 W ALBION ST APT C
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1279
Mailing Address - Country:US
Mailing Address - Phone:208-850-2346
Mailing Address - Fax:
Practice Address - Street 1:4747 W ALBION ST APT C
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1279
Practice Address - Country:US
Practice Address - Phone:208-850-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID44050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health