Healthcare Provider Details

I. General information

NPI: 1578503835
Provider Name (Legal Business Name): JOHN D. JEFFERS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TEA STREET
ROCKLAND ME
04841-3019
US

IV. Provider business mailing address

PO BOX 77
ROCKLAND ME
04841-0077
US

V. Phone/Fax

Practice location:
  • Phone: 207-592-4384
  • Fax:
Mailing address:
  • Phone: 207-976-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC3949
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: