Healthcare Provider Details

I. General information

NPI: 1790849735
Provider Name (Legal Business Name): SCOTT JAFFE L.M.H.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N UNIVERSITY DR SUITE 350
CORAL SPRINGS FL
33071-6089
US

IV. Provider business mailing address

1725 N UNIVERSITY DR SUITE 350
CORAL SPRINGS FL
33071-6089
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-0909
  • Fax: 954-755-5692
Mailing address:
  • Phone: 954-755-0909
  • Fax: 954-755-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: