Healthcare Provider Details

I. General information

NPI: 1316090566
Provider Name (Legal Business Name): JACQUELINE LEVY JAFFE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 SW 57TH CT SUITE 555
SOUTH MIAMI FL
33143-5317
US

IV. Provider business mailing address

1901 N PARK RD
HOLLYWOOD FL
33021-4817
US

V. Phone/Fax

Practice location:
  • Phone: 305-668-7999
  • Fax: 305-668-7988
Mailing address:
  • Phone: 954-343-8849
  • Fax: 954-343-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY6557
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: