Provider Demographics
NPI:1326177072
Name:JEFFERSON, DEXTER JAY JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DEXTER
Middle Name:JAY
Last Name:JEFFERSON
Suffix:JR
Gender:M
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:PO BOX 6362
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90734-6362
Mailing Address - Country:US
Mailing Address - Phone:310-593-4996
Mailing Address - Fax:
Practice Address - Street 1:28924 S WESTERN AVE STE 225
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0891
Practice Address - Country:US
Practice Address - Phone:310-593-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA750491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical