Provider Demographics
NPI:1184842056
Name:JEFFREY, ARGENTA JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ARGENTA
Middle Name:JANE
Last Name:JEFFREY
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 1:27 STATE ST
Mailing Address - Street 2:SUITE 63
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5113
Mailing Address - Country:US
Mailing Address - Phone:207-570-1123
Mailing Address - Fax:866-963-0160
Practice Address - Street 1:27 STATE ST
Practice Address - Street 2:SUITE 63
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5113
Practice Address - Country:US
Practice Address - Phone:207-570-1123
Practice Address - Fax:866-963-0160
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC42171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME247980099Medicaid