Provider Demographics
NPI:1912186149
Name:JAFFE, CATHERINE A (PMH CNS-BC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:JAFFE
Suffix:
Gender:F
Credentials:PMH CNS-BC
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Mailing Address - Street 1:CATHERINE JAFFE
Mailing Address - Street 2:58 MEDFORD STREET
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474
Mailing Address - Country:US
Mailing Address - Phone:857-756-3694
Mailing Address - Fax:617-475-5019
Practice Address - Street 1:CATHERINE JAFFE
Practice Address - Street 2:58 MEDFORD ST
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474
Practice Address - Country:US
Practice Address - Phone:857-756-3694
Practice Address - Fax:617-475-5019
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA183994364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA183994OtherLICENSE
MA183994OtherLICENSE