Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4793 | OH |
N | 103T00000X | Psychologist | 4793 | OH |
N | 102L00000X | Psychologist | PS006097L | PA |
N | 103T00000X | Psychologist | PS006097L | PA |
N | 103TA0700X | Adult Development & Aging Psychologist | 4793 | OH |
N | 103TA0700X | Adult Development & Aging Psychologist | PS006097L | PA |
N | 103G00000X | Clinical Psychologist | 4793 | OH |
N | 103TC0700X | Clinical Psychologist | 4793 | OH |
Y | 103G00000X | Clinical Psychologist | PS006097L | PA |
Y | 103TC0700X | Clinical Psychologist | PS006097L | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4793 | OH |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS006097L | PA |
NPI | 1689749384 |
---|---|
Provider Name | Gerald Lee Cipkala-Gaffin |
First Address | Wexford, PA 15090-7963 |
Second Address | Wexford, PA 15090-9274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 25/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014761210002 | (05) | PA |
0160730 | (05) | OH |
689830 | (02) | PA |