Provider Demographics
NPI:1376671602
Name:GAFFIN, MARJORIE L (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:L
Last Name:GAFFIN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S HOSPITAL GUIDANCE CENTERS
Mailing Address - Street 2:899 E. BROAD ST 3RD FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205
Mailing Address - Country:US
Mailing Address - Phone:614-355-8000
Mailing Address - Fax:614-355-8018
Practice Address - Street 1:CHILDREN'S HOSPITAL GUIDANCE CENTERS
Practice Address - Street 2:899 E. BROAD ST 3RD FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205
Practice Address - Country:US
Practice Address - Phone:614-355-8000
Practice Address - Fax:614-355-8018
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI23571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicare UPIN