Provider Demographics
NPI:1770112286
Name:JAFFREY, CARSON SEAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:CARSON
Middle Name:SEAN
Last Name:JAFFREY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4231 BALBOA AVE # 1218
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:858-752-7241
Mailing Address - Fax:
Practice Address - Street 1:11838 BERNARDO PLAZA CT STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2434
Practice Address - Country:US
Practice Address - Phone:858-776-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA938971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93897OtherCA BOARD OF BEHAVIORAL SCIENCES