Provider Demographics
NPI:1659919371
Name:JAFFE, ROBIN (LADAC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-2327
Mailing Address - Country:US
Mailing Address - Phone:901-726-4213
Mailing Address - Fax:901-726-4281
Practice Address - Street 1:1384 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2327
Practice Address - Country:US
Practice Address - Phone:901-726-4213
Practice Address - Fax:901-726-4281
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1320101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)