Provider Demographics
NPI:1194568311
Name:JAFFE, MISHA (MS)
Entity type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DANIEL RD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1824
Mailing Address - Country:US
Mailing Address - Phone:781-500-9126
Mailing Address - Fax:
Practice Address - Street 1:1 DANIEL RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1824
Practice Address - Country:US
Practice Address - Phone:781-500-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent