Provider Demographics
NPI:1245669506
Name:LAND, JEFFREY (LISW-S)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LAND
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7048 BENTLEY PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-2212
Mailing Address - Country:US
Mailing Address - Phone:440-352-1535
Mailing Address - Fax:
Practice Address - Street 1:7048 BENTLEY PL
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-2212
Practice Address - Country:US
Practice Address - Phone:440-352-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI17551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical