Provider Demographics
NPI:1497292676
Name:JAFFE, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 OAK ST
Mailing Address - Street 2:APT.407C
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1456
Mailing Address - Country:US
Mailing Address - Phone:617-285-8540
Mailing Address - Fax:
Practice Address - Street 1:30 EASTBROOK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-2048
Practice Address - Country:US
Practice Address - Phone:781-329-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1200181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical