Provider Demographics
NPI:1023229861
Name:JEFFERIS, ELISE MEREDITH (RN, LCSW)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:MEREDITH
Last Name:JEFFERIS
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PEMBROKE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6404
Mailing Address - Country:US
Mailing Address - Phone:724-396-1510
Mailing Address - Fax:724-691-0476
Practice Address - Street 1:123 N PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1229
Practice Address - Country:US
Practice Address - Phone:724-396-1510
Practice Address - Fax:724-691-0476
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0164331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168201ZDEJOtherMEDICARE PTAN
PA601018OtherMEDICAID VALUE OPTIONS