Provider Demographics
NPI:1013232644
Name:GAFFNEY-LIVINGSTONECONSULTATION SERVICE
Entity Type:Organization
Organization Name:GAFFNEY-LIVINGSTONECONSULTATION SERVICE
Other - Org Name:JOANNE GAFFNEY LIVINGSTONE, RN, LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:LIVINGSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-487-0455
Mailing Address - Street 1:522 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-2400
Mailing Address - Country:US
Mailing Address - Phone:508-487-0455
Mailing Address - Fax:508-487-5435
Practice Address - Street 1:522 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-2400
Practice Address - Country:US
Practice Address - Phone:508-487-0455
Practice Address - Fax:508-487-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
LA262902084P0800X
MA262902084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA29964Medicare PIN