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NPI Code Detail

MEDICARE: DEANNA JEFFERSON LCSW

MEDICARE: DEANNA JEFFERSON LCSW
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 WorkerLC21640ME
21041C0700XClinical Social Worker78558CA

General Provider Information

NPI Number : 1902318355
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA JEFFERSON LCSW
Provider Business Mailing Address
First Line : 3350 LA JOLLA VILLAGE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92161-0002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3350 LA JOLLA VILLAGE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92161-0002
Country : US
Telephone Number : 858-552-7455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2017
Last Update Date : 03/09/2026

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