Provider Demographics
NPI:1104112622
Name:JEFFREY, ABBY (LCSW)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:JEFFREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:BUSHLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9138 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6705
Mailing Address - Country:US
Mailing Address - Phone:718-704-8293
Mailing Address - Fax:
Practice Address - Street 1:9138 71ST AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6705
Practice Address - Country:US
Practice Address - Phone:718-704-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0809971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical