Provider Demographics
NPI:1326165655
Name:ALAN A JAFFE PHD & ASSOCIATES PA
Entity Type:Organization
Organization Name:ALAN A JAFFE PHD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-755-0909
Mailing Address - Street 1:3080 NW 99TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4038
Mailing Address - Country:US
Mailing Address - Phone:954-755-0909
Mailing Address - Fax:954-755-5692
Practice Address - Street 1:3080 NW 99TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4038
Practice Address - Country:US
Practice Address - Phone:954-755-0909
Practice Address - Fax:954-755-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3317103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75276OtherBLUE CROSS BLUE SHIELD
FL75276AMedicare ID - Type UnspecifiedMEDICARE