Provider Demographics
NPI:1467798876
Name:JEFFERSON, ANTHONY B SR (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:B
Last Name:JEFFERSON
Suffix:SR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-8466
Mailing Address - Country:US
Mailing Address - Phone:610-709-7772
Mailing Address - Fax:
Practice Address - Street 1:1280 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-8466
Practice Address - Country:US
Practice Address - Phone:610-709-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional