Provider Demographics
NPI:1649242504
Name:YAFFE, PETER ELLIOT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ELLIOT
Last Name:YAFFE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 D BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776
Mailing Address - Country:US
Mailing Address - Phone:978-443-4262
Mailing Address - Fax:978-443-4262
Practice Address - Street 1:327 D BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776
Practice Address - Country:US
Practice Address - Phone:978-443-4262
Practice Address - Fax:978-443-4262
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1862103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
2011965OtherCIGNA HEALTH CARE
A001746OtherVALUE OPTIONS
W01977OtherBLUE SHIELD OF MASS
095701OtherTRICARE
5353041OtherAETNA
MA0513911Medicaid
095701OtherMANAGED HEALTH NETWORK
MA706892OtherTUFTS HEALTH PLAN
095701OtherMANAGED HEALTH NETWORK