Provider Demographics
NPI:1558770057
Name:JAFFE, BRADLEY (LMSW)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:JAFFE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2344
Mailing Address - Country:US
Mailing Address - Phone:561-213-0361
Mailing Address - Fax:
Practice Address - Street 1:5410 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2344
Practice Address - Country:US
Practice Address - Phone:561-213-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0924061041C0700X
FLISW106841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical