Provider Demographics
NPI:1932443603
Name:JONES, PHAEDRA SHAWNTIA (MSW)
Entity Type:Individual
Prefix:MS
First Name:PHAEDRA
Middle Name:SHAWNTIA
Last Name:JONES
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 1:340 MAIN ST STE 818
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1692
Mailing Address - Country:US
Mailing Address - Phone:508-791-4976
Mailing Address - Fax:508-791-6723
Practice Address - Street 1:340 MAIN ST STE 818
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1692
Practice Address - Country:US
Practice Address - Phone:508-791-4976
Practice Address - Fax:508-791-6723
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool