Provider Demographics
NPI:1669694733
Name:WHITE, JEFFREY NEIL (LICSW, ACSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:NEIL
Last Name:WHITE
Suffix:
Gender:M
Credentials:LICSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LINCOLN ST # 272
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3001
Mailing Address - Country:US
Mailing Address - Phone:781-589-8784
Mailing Address - Fax:
Practice Address - Street 1:15 LINCOLN ST # 272
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3001
Practice Address - Country:US
Practice Address - Phone:781-589-8784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10193891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical