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NPI Code Detail

MEDICARE: JULIE ANNE JEFFERS MSW

MEDICARE: JULIE ANNE JEFFERS MSW
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
1104100000XSocial Worker
21041C0700XClinical Social Worker099336NY

General Provider Information

NPI Number : 1912587643
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE ANNE JEFFERS MSW
Provider Business Mailing Address
First Line : 22 DEPOT ST
Second Line :
City : ANTWERP
State : NY
Zip : 13608-3182
Country : US
Telephone Number : 208-310-9936
Fax Number :
Provider Business Practice Location Address
First Line : 650 STATE ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2839
Country : US
Telephone Number : 518-651-2302
Fax Number : 315-291-6601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2021
Last Update Date : 02/11/2025

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