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General NPI Number Information
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NPI Number | 1497244503
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Entity Type | Individual
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Provider Name | ASTRIA GAFFORD LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-1000
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Country | US
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Telephone | 909-825-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 12971 MORENO BEACH DR APT 10206
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4425
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Country | US
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Telephone | 912-222-7588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW133934
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 101410
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License Number State | CA
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