Provider Demographics
NPI:1912587643
Name:JEFFERS, JULIE ANNE (MSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:ANTWERP
Mailing Address - State:NY
Mailing Address - Zip Code:13608-3182
Mailing Address - Country:US
Mailing Address - Phone:208-310-9936
Mailing Address - Fax:
Practice Address - Street 1:16 PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-2016
Practice Address - Country:US
Practice Address - Phone:315-764-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical