Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 416 | VT |
NPI | 1053477455 |
---|---|
Provider Name | Ms. Aimee Idelle Gaffney |
First Address | Burlington, VT 05401-1319 |
Second Address | Burlington, VT 05401-4299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0625228 | PROVIDER NUMBER (01) | VT |