Provider Demographics
NPI:1083453328
Name:GAFFNEY, TARA MCKENNA (LMHC-P)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MCKENNA
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:LMHC-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2851
Mailing Address - Country:US
Mailing Address - Phone:585-727-1088
Mailing Address - Fax:
Practice Address - Street 1:222 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1860
Practice Address - Country:US
Practice Address - Phone:585-641-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP124563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health