Provider Demographics
NPI:1124205497
Name:JEFFERSON, ROCHELLE M (LMSW)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:M
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18279 MENDOTA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1944
Mailing Address - Country:US
Mailing Address - Phone:313-386-4032
Mailing Address - Fax:
Practice Address - Street 1:18279 MENDOTA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1944
Practice Address - Country:US
Practice Address - Phone:313-386-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010774211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical