Provider Demographics
NPI:1699831396
Name:GAFFIN, ILENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:
Last Name:GAFFIN
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 1:320 LINN ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3719
Mailing Address - Country:US
Mailing Address - Phone:607-275-0558
Mailing Address - Fax:
Practice Address - Street 1:120 E BUFFALO ST
Practice Address - Street 2:STE 4
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4266
Practice Address - Country:US
Practice Address - Phone:607-275-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0226201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
138407OtherVO BMP
209429OtherEXCELLUS HMO BLUE
28552230OtherEXCELLUS CNY CSWR
5059010OtherAETNA
0005363002OtherGHI EMPIRE
000914002001OtherHEALTH NOW
NY56568BMedicare ID - Type Unspecified