Provider Demographics
NPI:1437263027
Name:CAPE, JEFFRIE KON (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JEFFRIE
Middle Name:KON
Last Name:CAPE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5079 LANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2016
Mailing Address - Country:US
Mailing Address - Phone:248-661-2818
Mailing Address - Fax:
Practice Address - Street 1:1350 E WEST MAPLE RD
Practice Address - Street 2:STE 8
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3727
Practice Address - Country:US
Practice Address - Phone:248-730-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010636101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical