Provider Demographics
NPI:1467492157
Name:MUNSON, JEFFREY CHARLES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:MUNSON
Suffix:
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 1:277 ALEXANDER ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607
Mailing Address - Country:US
Mailing Address - Phone:585-423-0284
Mailing Address - Fax:585-423-0284
Practice Address - Street 1:277 ALEXANDER ST
Practice Address - Street 2:SUITE 302
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607
Practice Address - Country:US
Practice Address - Phone:585-423-0284
Practice Address - Fax:585-423-0284
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01968211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
100362FKOtherPREFERRED CARE HMO
NY01991771Medicaid
NY01991771Medicaid