Provider Demographics
NPI:1316090566
Name:JAFFE, JACQUELINE LEVY (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LEVY
Last Name:JAFFE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 N PARK RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4817
Mailing Address - Country:US
Mailing Address - Phone:954-343-8849
Mailing Address - Fax:954-343-8849
Practice Address - Street 1:7301 SW 57TH CT
Practice Address - Street 2:SUITE 555
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5317
Practice Address - Country:US
Practice Address - Phone:305-668-7999
Practice Address - Fax:305-668-7988
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6557103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent