Healthcare Provider Details

I. General information

NPI: 1871811505
Provider Name (Legal Business Name): ADRIENNE CLAIRE JEFFRIES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 BAY RIDGE AVE STE 190
ANNAPOLIS MD
21403-2834
US

IV. Provider business mailing address

2925 QUEENSBERRY DR
HUNTINGTOWN MD
20639-2325
US

V. Phone/Fax

Practice location:
  • Phone: 443-281-9430
  • Fax:
Mailing address:
  • Phone: 774-413-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012067
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25432
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: