Healthcare Provider Details

I. General information

NPI: 1538245287
Provider Name (Legal Business Name): MAUREEN GAFFEY, PSY. D., LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 UNIVERSITY AVE W SUITE 303
SAINT PAUL MN
55104-3898
US

IV. Provider business mailing address

1600 UNIVERSITY AVE W SUITE 303
SAINT PAUL MN
55104-3898
US

V. Phone/Fax

Practice location:
  • Phone: 651-644-1813
  • Fax: 651-644-1870
Mailing address:
  • Phone: 651-644-1813
  • Fax: 651-644-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3649
License Number StateMN

VIII. Authorized Official

Name: MAUREEN GAFFEY
Title or Position: CHIEF MANAGER/PSYCHOLOGIST
Credential: PSY.D.
Phone: 651-644-1813