MEDICARE: DANA JEFFERY LMSW

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	6801096963	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6851096963	OTHER	MI	LMSW

General Provider Information

NPI Number	:	1669846614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA JEFFERY LMSW

Provider Business Mailing Address
First Line	:	31201 CHICAGO RD S STE A201
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5552
Country	:	US
Telephone Number	:	248-543-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S STE A201
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5552
Country	:	US
Telephone Number	:	248-543-0033
Fax Number	:

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

Provider Enumeration Date	:	11/13/2015
Last Update Date	:	11/11/2025

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Directions to “ DANA JEFFERY LMSW” Practice Location

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