Provider Demographics
NPI:1205041019
Name:JAFFEE, FREDERIC T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:T
Last Name:JAFFEE
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 1:446 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3616
Mailing Address - Country:US
Mailing Address - Phone:718-965-9333
Mailing Address - Fax:
Practice Address - Street 1:8 GRAMERCY PARK S
Practice Address - Street 2:SUITE 2J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1718
Practice Address - Country:US
Practice Address - Phone:917-572-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7893103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical