MEDICARE: KATHY JAFFE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	LCSW64241	CA

General Provider Information

NPI Number	:	1255528550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY JAFFE

Provider Business Mailing Address
First Line	:	PO BOX 173
Second Line	:
City	:	ANGELUS OAKS
State	:	CA
Zip	:	92305-0173
Country	:	US
Telephone Number	:	909-557-0314
Fax Number	:

Provider Business Practice Location Address
First Line	:	6002 LAKE DRIVE
Second Line	:
City	:	ANGELUS OAKS
State	:	CA
Zip	:	92305-9230
Country	:	US
Telephone Number	:	909-557-0314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	10/14/2020

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Directions to “ KATHY JAFFE ” Practice Location

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