Provider Demographics
NPI:1366108466
Name:RAFFLOER, GAVIN C
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:C
Last Name:RAFFLOER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 SOUTHWESTERN BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1749
Mailing Address - Country:US
Mailing Address - Phone:716-895-7207
Mailing Address - Fax:716-667-6808
Practice Address - Street 1:3671 SOUTHWESTERN BLVD STE 209
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1749
Practice Address - Country:US
Practice Address - Phone:716-895-7207
Practice Address - Fax:716-667-6808
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health