Provider Demographics
NPI:1275674103
Name:YAFFE, SAMUEL MARK (PHD, LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MARK
Last Name:YAFFE
Suffix:
Gender:M
Credentials:PHD, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16109 MARKOE RD
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1716
Mailing Address - Country:US
Mailing Address - Phone:443-831-5871
Mailing Address - Fax:410-472-3129
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD057261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD827M441FMedicare ID - Type Unspecified