Provider Demographics
NPI:1568549426
Name:LANDIS, JEFFREY L (LCSW, DCSW)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:LANDIS
Suffix:
Gender:M
Credentials:LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 E WEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3047
Mailing Address - Country:US
Mailing Address - Phone:540-434-6354
Mailing Address - Fax:
Practice Address - Street 1:59 E WEAVER AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3047
Practice Address - Country:US
Practice Address - Phone:540-434-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2016-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891871711Medicaid
VADD4151OtherRAILROAD MEDICARE GROUP NUMBER
VA800013528OtherRAILROAD MEDICARE NUMBER
VA277940OtherANTHEM PROVIDER NUMBER
VACO8457Medicare PIN
VA1891871711Medicaid