Healthcare Provider Details

I. General information

NPI: 1821147828
Provider Name (Legal Business Name): KATHLEEN M LYNCH GAFFNEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 BEACH CHANNEL DR JOSEPH P ADDABBO FAMILY HEALTH
ARVERNE NY
11692
US

IV. Provider business mailing address

329 UNION ST #4E
BROOKLYN NY
11231
US

V. Phone/Fax

Practice location:
  • Phone: 718-945-7150
  • Fax: 718-634-4838
Mailing address:
  • Phone: 718-945-7150
  • Fax: 718-634-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR036173
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: