Healthcare Provider Details

I. General information

NPI: 1689749384
Provider Name (Legal Business Name): GERALD LEE CIPKALA-GAFFIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GERALD LEE GAFFIN PH.D.

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 MATTERHORN DR
WEXFORD PA
15090-7963
US

IV. Provider business mailing address

2523 MATTERHORN DR
WEXFORD PA
15090-7963
US

V. Phone/Fax

Practice location:
  • Phone: 412-916-7287
  • Fax: 724-940-2363
Mailing address:
  • Phone: 724-940-2363
  • Fax: 724-940-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS006097L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS006097L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006097L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPS006097L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number4793
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4793
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4793
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4793
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: