Provider Demographics
NPI:1295695641
Name:JAFARI, AMAL
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9259
Mailing Address - Country:US
Mailing Address - Phone:937-380-9909
Mailing Address - Fax:
Practice Address - Street 1:6213 EAGLE POINT DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-9259
Practice Address - Country:US
Practice Address - Phone:937-380-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5494919103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service