Healthcare Provider Details

I. General information

NPI: 1902145824
Provider Name (Legal Business Name): ELIZABETH A JEFFERY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 WEST ST
CANANDAIGUA NY
14424-1722
US

IV. Provider business mailing address

3180 WEST ST
CANANDAIGUA NY
14424-1722
US

V. Phone/Fax

Practice location:
  • Phone: 607-368-9141
  • Fax:
Mailing address:
  • Phone: 607-368-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number096864
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: