Provider Demographics
NPI:1427590355
Name:MACIEJ, JEFFREY (LICSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MACIEJ
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 UNIVERSITY AVENUE WEST
Mailing Address - Street 2:CATHOLIC CHARITIES OF ST. PAUL AND MINNEAPOLIS
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4101
Mailing Address - Country:US
Mailing Address - Phone:612-432-0053
Mailing Address - Fax:612-623-2119
Practice Address - Street 1:1276 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4101
Practice Address - Country:US
Practice Address - Phone:612-432-0053
Practice Address - Fax:612-623-2119
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN197201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical