Provider Demographics
NPI:1639200637
Name:JEFFREY, JUSTINE L (CMTPT)
Entity type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:L
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PROSPECT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6469
Mailing Address - Country:US
Mailing Address - Phone:802-251-0155
Mailing Address - Fax:
Practice Address - Street 1:6 PROSPECT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6469
Practice Address - Country:US
Practice Address - Phone:802-251-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
989906OtherCMTPT