Healthcare Provider Details

I. General information

NPI: 1134059819
Provider Name (Legal Business Name): KEVIN PATRICK GAFFNEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 STONUM RD
MODESTO CA
95351-5121
US

IV. Provider business mailing address

1336 STONUM RD
MODESTO CA
95351-5121
US

V. Phone/Fax

Practice location:
  • Phone: 209-505-2913
  • Fax: 209-541-2395
Mailing address:
  • Phone: 209-505-2913
  • Fax: 209-541-2395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW26130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: