Healthcare Provider Details

I. General information

NPI: 1659461499
Provider Name (Legal Business Name): AURALEE JEFFERDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LIBERTY ST
BATH NY
14810-1508
US

IV. Provider business mailing address

7454 SENECA RD N
HORNELL NY
14843-9141
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-6577
  • Fax:
Mailing address:
  • Phone: 607-324-2483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number072676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: