Provider Demographics
NPI:1114068046
Name:SAMUEL YAFFE, PH.D., INCORPORATED
Entity Type:Organization
Organization Name:SAMUEL YAFFE, PH.D., INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:YAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-323-3232
Mailing Address - Street 1:2 HAMILL RD STE 324-C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1813
Mailing Address - Country:US
Mailing Address - Phone:410-323-3232
Mailing Address - Fax:410-472-3735
Practice Address - Street 1:2 HAMILL RD STE 324-C
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1813
Practice Address - Country:US
Practice Address - Phone:410-323-3232
Practice Address - Fax:410-472-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD057261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD827MMedicare ID - Type Unspecified