Healthcare Provider Details

I. General information

NPI: 1992076145
Provider Name (Legal Business Name): ADI JAFFE MCAP, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 KENWAY AVE
VIEW PARK CA
90008-4810
US

IV. Provider business mailing address

4144 KENWAY AVE
VIEW PARK CA
90008-4810
US

V. Phone/Fax

Practice location:
  • Phone: 310-488-3978
  • Fax:
Mailing address:
  • Phone: 888-557-7217
  • Fax: 888-739-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1206182052
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCI11210418
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number191199AP
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: