Provider Demographics
NPI:1114075306
Name:GEFFEN, JEAN TAMARA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:TAMARA
Last Name:GEFFEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOMERSET DR S
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1821
Mailing Address - Country:US
Mailing Address - Phone:516-466-7876
Mailing Address - Fax:
Practice Address - Street 1:11045 71ST RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4960
Practice Address - Country:US
Practice Address - Phone:718-520-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR023863-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical