Healthcare Provider Details

I. General information

NPI: 1053477455
Provider Name (Legal Business Name): AIMEE IDELLE GAFFNEY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHURCH ST SUITE 4A
BURLINGTON VT
05401-4299
US

IV. Provider business mailing address

13 GREY MEADOW DR
BURLINGTON VT
05401-1319
US

V. Phone/Fax

Practice location:
  • Phone: 802-863-9393
  • Fax: 802-286-3939
Mailing address:
  • Phone: 802-660-0732
  • Fax: 802-863-9393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number416
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: