Provider Demographics
NPI:1386258846
Name:KANE, MICHELA GAFFNEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELA
Middle Name:GAFFNEY
Last Name:KANE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MICHELA
Other - Middle Name:BURKE
Other - Last Name:GAFFNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2296 HENDERSON MILL RD NE STE 402
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2739
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:
Practice Address - Street 1:2296 HENDERSON MILL RD NE STE 402
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2739
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical