Provider Demographics
NPI:1326222001
Name:JEFFREY, IRWIN ANTHONY (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:ANTHONY
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MACDONOUGH ST
Mailing Address - Street 2:16
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2330
Mailing Address - Country:US
Mailing Address - Phone:718-398-3910
Mailing Address - Fax:
Practice Address - Street 1:1456 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2505
Practice Address - Country:US
Practice Address - Phone:718-636-4500
Practice Address - Fax:347-296-8310
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0488611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical