Healthcare Provider Details

I. General information

NPI: 1417391665
Provider Name (Legal Business Name): GAELLE AFFIANY MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PILLING ST
BROOKLYN NY
11207-1610
US

IV. Provider business mailing address

14320 182ND PL
SPRINGFIELD GARDENS NY
11413-3221
US

V. Phone/Fax

Practice location:
  • Phone: 718-602-1000
  • Fax: 718-602-1111
Mailing address:
  • Phone: 917-331-0961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: