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NPI Code Detail

MEDICARE: CANDACE MARIE JEFFRIES L.C.S.W.

MEDICARE: CANDACE MARIE JEFFRIES L.C.S.W.
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
11041C0700XClinical Social Worker3042KY

General Provider Information

NPI Number : 1689766644
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE MARIE JEFFRIES L.C.S.W.
Provider Business Mailing Address
First Line : 151 MAKENZIE LN
Second Line :
City : LONDON
State : KY
Zip : 40744-9487
Country : US
Telephone Number : 606-878-2141
Fax Number :
Provider Business Practice Location Address
First Line : 1675 S MAIN ST
Second Line :
City : LONDON
State : KY
Zip : 40741-2050
Country : US
Telephone Number : 606-878-1961
Fax Number : 606-877-1958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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