Provider Demographics
NPI:1669901807
Name:SOUTH CAPE PSYCHIATRIC SERVICES PLLC
Entity type:Organization
Organization Name:SOUTH CAPE PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-957-8063
Mailing Address - Street 1:312 RED BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3761
Mailing Address - Country:US
Mailing Address - Phone:617-957-8063
Mailing Address - Fax:
Practice Address - Street 1:446 WAQUOIT HWY
Practice Address - Street 2:
Practice Address - City:WAQUOIT
Practice Address - State:MA
Practice Address - Zip Code:02536-5522
Practice Address - Country:US
Practice Address - Phone:774-255-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-10
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267688363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty