Provider Demographics
NPI:1497184980
Name:JEFFERY, KAREN MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MARIE
Last Name:JEFFERY
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 1:2417 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2219
Mailing Address - Country:US
Mailing Address - Phone:248-874-1282
Mailing Address - Fax:248-874-1501
Practice Address - Street 1:691 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2039
Practice Address - Country:US
Practice Address - Phone:248-874-1282
Practice Address - Fax:248-874-1501
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010668381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical