Healthcare Provider Details

I. General information

NPI: 1124178231
Provider Name (Legal Business Name): YVONNE MADERA-JAFFE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 CALIFORNIA ST
SAN FRANCISCO CA
94118-1376
US

IV. Provider business mailing address

514 NORTHERN AVE
MILL VALLEY CA
94941-3781
US

V. Phone/Fax

Practice location:
  • Phone: 415-334-7249
  • Fax:
Mailing address:
  • Phone: 415-334-7249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 14001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: