Healthcare Provider Details

I. General information

NPI: 1891601415
Provider Name (Legal Business Name): KATHRYN MARY JAFFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 MAIN ST
MATAWAN NJ
07747-3104
US

IV. Provider business mailing address

8 MILLAY CT
FREEHOLD NJ
07728-4325
US

V. Phone/Fax

Practice location:
  • Phone: 732-290-9040
  • Fax:
Mailing address:
  • Phone: 848-863-7736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: