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NPI Code Detail

MEDICARE: JEFFREY C ALBERTS LSW, MS, CPRP

MEDICARE: JEFFREY C ALBERTS LSW, MS, CPRP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker9475MN

General Provider Information

NPI Number : 1194859876
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY C ALBERTS LSW, MS, CPRP
Provider Business Mailing Address
First Line : 5615 BROOKLYN BLVD STE 200
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55429-3086
Country : US
Telephone Number : 763-537-6612
Fax Number :
Provider Business Practice Location Address
First Line : 5615 BROOKLYN BLVD STE 200
Second Line :
City : BROOKLYN CENTER
State : MN
Zip : 55429-3086
Country : US
Telephone Number : 763-537-6612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/09/2007

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