Healthcare Provider Details

I. General information

NPI: 1023229861
Provider Name (Legal Business Name): ELISE MEREDITH JEFFERIS RN, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N PITTSBURGH ST
ZELIENOPLE PA
16063-1229
US

IV. Provider business mailing address

101 PEMBROKE CT
GREENSBURG PA
15601-6404
US

V. Phone/Fax

Practice location:
  • Phone: 724-396-1510
  • Fax: 724-691-0476
Mailing address:
  • Phone: 724-396-1510
  • Fax: 724-691-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016433
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier168201ZDEJ
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICARE PTAN
# 2
Identifier601018
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAID VALUE OPTIONS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: