Provider Demographics
NPI:1497301378
Name:JAFFE, ALYSSA R
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
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 1:1 WESTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-1022
Mailing Address - Country:US
Mailing Address - Phone:443-559-1031
Mailing Address - Fax:
Practice Address - Street 1:1 WESTVILLE RD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-1022
Practice Address - Country:US
Practice Address - Phone:443-559-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008415101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health