Provider Demographics
NPI:1912587643
Name:JEFFERS, JULIE ANNE (MSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:JEFFERS
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 1:22 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:ANTWERP
Mailing Address - State:NY
Mailing Address - Zip Code:13608-3182
Mailing Address - Country:US
Mailing Address - Phone:208-310-9936
Mailing Address - Fax:
Practice Address - Street 1:650 STATE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2839
Practice Address - Country:US
Practice Address - Phone:518-651-2302
Practice Address - Fax:315-291-6601
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY0993361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker