Provider Demographics
NPI:1659438216
Name:GAFFNEY, BERNADETTE R (LCSW)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:R
Last Name:GAFFNEY
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 1:2000 N RACINE AVE
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4045
Mailing Address - Country:US
Mailing Address - Phone:773-430-9644
Mailing Address - Fax:773-770-3577
Practice Address - Street 1:2000 N RACINE AVE
Practice Address - Street 2:SUITE 2020
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4045
Practice Address - Country:US
Practice Address - Phone:773-430-9644
Practice Address - Fax:773-770-3577
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0076241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633611OtherBLUE CROSS &BLUE SHIELD
IL566044OtherVALUE OPTIONS
IL300212612OtherAETNA
IL207045Medicare ID - Type UnspecifiedMEDICARE PROVIDER #