Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E WARM SPRINGS AVE STE B
BOISE ID
83712-6457
US

IV. Provider business mailing address

750 E WARM SPRINGS AVE STE B
BOISE ID
83712-6457
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-3209
  • Fax: 208-537-7951
Mailing address:
  • Phone: 505-226-3209
  • Fax: 208-537-7951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW8911427
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: