Provider Demographics
NPI:1932338449
Name:JEFFERSON, PATRICIA MOODY (MSW, LCSW-C, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MOODY
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MSW, LCSW-C, LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MOODY
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW-C, LCSW
Mailing Address - Street 1:3405 W FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1426
Mailing Address - Country:US
Mailing Address - Phone:443-928-3121
Mailing Address - Fax:410-744-4253
Practice Address - Street 1:3405 W FOREST PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1426
Practice Address - Country:US
Practice Address - Phone:443-928-3121
Practice Address - Fax:410-744-4253
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0067381041C0700X
MD231011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical