MEDICARE: MS. SHERYL DENISE JEFFERSON LCSW-C

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
1	101YM0800X	Mental Health Counselor	11957	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811177488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERYL DENISE JEFFERSON LCSW-C

Provider Business Mailing Address
First Line	:	8850 COLUMBIA 100 PKWY
Second Line	:	203
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2374
Country	:	US
Telephone Number	:	443-546-4476
Fax Number	:	443-546-4473

Provider Business Practice Location Address
First Line	:	8850 COLUMBIA 100 PKWY
Second Line	:	203
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2374
Country	:	US
Telephone Number	:	443-546-4476
Fax Number	:	443-546-4473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	06/11/2012

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