Provider Demographics
NPI:1134516636
Name:JAFFE, ROBERT BERNARD (PHD,LMFT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BERNARD
Last Name:JAFFE
Suffix:
Gender:M
Credentials:PHD,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 VENTURA BLVD., SUITE 520
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-906-7079
Mailing Address - Fax:818-906-7079
Practice Address - Street 1:15720 VENTURA BLVD., SUITE 520
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-906-7079
Practice Address - Fax:818-906-7079
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT19513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist