Provider Demographics
NPI:1497953483
Name:GAFFEN, LEA AIMEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEA
Middle Name:AIMEE
Last Name:GAFFEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 HIGHWAY A1A APT 403
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3595
Mailing Address - Country:US
Mailing Address - Phone:703-609-5559
Mailing Address - Fax:
Practice Address - Street 1:1907 HIGHWAY A1A APT 403
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3595
Practice Address - Country:US
Practice Address - Phone:703-609-5559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-06004081041S0200X
VA09040065821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool