Provider Demographics
NPI:1831240902
Name:JAFFE, ALAN A (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:A
Last Name:JAFFE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:A
Other - Last Name:JAFFE, PH.D. & ASSOCIATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:807 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4180
Mailing Address - Country:US
Mailing Address - Phone:954-755-0909
Mailing Address - Fax:954-755-5692
Practice Address - Street 1:807 CORAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071
Practice Address - Country:US
Practice Address - Phone:954-755-0909
Practice Address - Fax:954-755-5692
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3317103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1326165655OtherNPI INDIVIDUAL NUMBER
24207OtherMEDICARE GROUP PTN
FL24207OtherBLUE CROSS BLUE SHIELD GROUP #
FL75276OtherBLUE CROSS BLUE SHIELD
FL24207OtherBLUE CROSS BLUE SHIELD GROUP #