Provider Demographics
NPI:1184721003
Name:GAFFNEY, THOMAS JOSEPH (PSY D)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:GAFFNEY
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:STOCKTON SPRINGS
Mailing Address - State:ME
Mailing Address - Zip Code:04981
Mailing Address - Country:US
Mailing Address - Phone:207-469-2255
Mailing Address - Fax:207-469-2299
Practice Address - Street 1:103 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-469-2255
Practice Address - Fax:207-469-2299
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS427103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME703742Medicare ID - Type Unspecified