Provider Demographics
NPI:1992076145
Name:JAFFE, ADI (MCAP, CADC)
Entity type:Individual
Prefix:
First Name:ADI
Middle Name:
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MCAP, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 KENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90008-4810
Mailing Address - Country:US
Mailing Address - Phone:888-557-7217
Mailing Address - Fax:888-739-6925
Practice Address - Street 1:4144 KENWAY AVE
Practice Address - Street 2:
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90008-4810
Practice Address - Country:US
Practice Address - Phone:310-488-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1206182052101YA0400X
CALCI11210418101YA0400X
CA103TA0400X
CA191199AP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)