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NPI Code Detail

MEDICARE: JEFF WORLEY LICSW

MEDICARE: JEFF WORLEY LICSW
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
11041C0700XClinical Social Worker17030MN

General Provider Information

NPI Number : 1982761342
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFF WORLEY LICSW
Provider Business Mailing Address
First Line : 3490 LEXINGTON AVE N
Second Line :
City : SHOREVIEW
State : MN
Zip : 55126-8074
Country : US
Telephone Number : 651-486-3808
Fax Number : 651-486-3858
Provider Business Practice Location Address
First Line : 3490 LEXINGTON AVE N
Second Line :
City : SHOREVIEW
State : MN
Zip : 55126-8074
Country : US
Telephone Number : 651-486-3808
Fax Number : 651-486-3858
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 07/08/2007

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Directions to “ JEFF WORLEY LICSW” Practice Location

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