Provider Information for 1265709364
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EMERY JEFFERIES LGSW
Sex: Male
NPI: 1265709364
Last Updated: 2011-11-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1265709364 | ||||||||
| Enumeration Date | 2011-11-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1400 MERCANTILE LN #232 LARGO, MD 20774-5341 United States Phone: 301-583-0001 | Fax: | ||||||||
| Primary Practice Address | 1400 MERCANTILE LN #232 LARGO, MD 20774-5341 United States Phone: 301-583-0001 | Fax: | ||||||||
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