MEDICARE: JENNIFER L PFEFFER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW014588	PA

General Provider Information

NPI Number	:	1518041177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L PFEFFER LCSW

Provider Business Mailing Address
First Line	:	3800 W 12TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-3380
Country	:	US
Telephone Number	:	814-923-8410
Fax Number	:	814-315-6044

Provider Business Practice Location Address
First Line	:	3800 W 12TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-3380
Country	:	US
Telephone Number	:	814-923-8410
Fax Number	:	914-315-6044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/06/2017

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