Provider Demographics
NPI:1730305145
Name:JEFFERS, MICHELE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 CASCADE DR S
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4929
Mailing Address - Country:US
Mailing Address - Phone:609-923-1401
Mailing Address - Fax:
Practice Address - Street 1:300 HARPER DR
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3208
Practice Address - Country:US
Practice Address - Phone:609-261-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052671001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical