Provider Demographics
NPI:1124317912
Name:JEFFERY, KENNETH EVERETT
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EVERETT
Last Name:JEFFERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BRIGHAM ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2210
Mailing Address - Country:US
Mailing Address - Phone:508-993-8332
Mailing Address - Fax:508-993-1024
Practice Address - Street 1:52 BRIGHAM ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2210
Practice Address - Country:US
Practice Address - Phone:508-993-8332
Practice Address - Fax:508-993-1024
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical