Healthcare Provider Details

I. General information

NPI: 1053851972
Provider Name (Legal Business Name): DEANNA JEFFRIES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 01/29/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 3031, CAMP HUMPHREYS
APO AP
96271
US

IV. Provider business mailing address

OPC 371 BOX 39
APO AP
96271-9001
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-5668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 14086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: