Healthcare Provider Details

I. General information

NPI: 1700927746
Provider Name (Legal Business Name): MITCHELL JAFFE MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CLARK AVE
WELLFLEET MA
02667-7530
US

IV. Provider business mailing address

126 CLARK AVE
WELLFLEET MA
02667-7530
US

V. Phone/Fax

Practice location:
  • Phone: 315-345-8886
  • Fax:
Mailing address:
  • Phone: 315-345-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00142-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: