Mona Gustafson Affinito, PH.D/

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP3080 Issued in MN

Practice address

1359 White Oak Dr
Chaska, MN 55318-1401

Phone

(952) 361-3681

Fax

(952) 361-3761

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992815872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1359 WHITE OAK DR",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181401",
            "telephone_number": "952-361-3681",
            "fax_number": "952-361-3761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 WHITE OAK DR",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181401",
            "telephone_number": "952-361-3681",
            "fax_number": "952-361-3761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AFFINITO",
        "first_name": "MONA",
        "middle_name": "GUSTAFSON",
        "name_prefix": "Dr.",
        "credential": "PH.D/",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP3080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Chaska, MN
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.