Provider Demographics
NPI:1194859876
Name:ALBERTS, JEFFREY C (LSW, MS, CPRP)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:ALBERTS
Suffix:
Gender:M
Credentials:LSW, MS, CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 BROOKLYN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3086
Mailing Address - Country:US
Mailing Address - Phone:763-537-6612
Mailing Address - Fax:
Practice Address - Street 1:5615 BROOKLYN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3086
Practice Address - Country:US
Practice Address - Phone:763-537-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9475104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker