Healthcare Provider Details

I. General information

NPI: 1871275032
Provider Name (Legal Business Name): MICHAELA GAFFNEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 S VISTA AVE
BOISE ID
83705-7352
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-782-4974
  • Fax: 208-466-5359
Mailing address:
  • Phone: 208-467-4431
  • Fax: 208-466-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-44050
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44050
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: