Provider Demographics
NPI:1053477455
Name:GAFFNEY, AIMEE IDELLE (MA)
Entity Type:Individual
Prefix:MS
First Name:AIMEE
Middle Name:IDELLE
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GREY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1319
Mailing Address - Country:US
Mailing Address - Phone:802-660-0732
Mailing Address - Fax:802-863-9393
Practice Address - Street 1:2 CHURCH ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4299
Practice Address - Country:US
Practice Address - Phone:802-863-9393
Practice Address - Fax:802-286-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT416103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0625228OtherPROVIDER NUMBER