Provider Demographics
NPI:1881741791
Name:JAFFE, JACOB (EDD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:JAFFE
Suffix:
Gender:
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 FENTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5643
Mailing Address - Country:US
Mailing Address - Phone:718-547-3412
Mailing Address - Fax:
Practice Address - Street 1:2514 FENTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5643
Practice Address - Country:US
Practice Address - Phone:718-547-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3399103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling