Provider Demographics
NPI:1154743797
Name:JEFFRIES, QUAVONNA
Entity type:Individual
Prefix:
First Name:QUAVONNA
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 JENNINGS ST
Mailing Address - Street 2:2B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459
Mailing Address - Country:US
Mailing Address - Phone:347-482-7706
Mailing Address - Fax:
Practice Address - Street 1:590 AVE OF THE AMERICAS
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:347-712-0125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker