Provider Demographics
NPI:1770101495
Name:JEFFERSON, SHARLIMAR DENISE
Entity type:Individual
Prefix:MS
First Name:SHARLIMAR
Middle Name:DENISE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MARICE CIR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5814
Mailing Address - Country:US
Mailing Address - Phone:301-377-6564
Mailing Address - Fax:
Practice Address - Street 1:51 MARICE CIR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-5814
Practice Address - Country:US
Practice Address - Phone:301-377-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician