Provider Demographics
NPI:1083191845
Name:JAFFE, PHILIP DAVID (PSYD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:DAVID
Last Name:JAFFE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AVENUE DU MAIL
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:GE
Mailing Address - Zip Code:CH1205
Mailing Address - Country:CH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 AVENUE DU MAIL
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:GE
Practice Address - Zip Code:CH1205
Practice Address - Country:CH
Practice Address - Phone:412-232-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5099103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist