Provider Demographics
NPI:1679310494
Name:PFEIFER, JONATHAN GERARD
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:GERARD
Last Name:PFEIFER
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 1:917 OLD BARON DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7000
Mailing Address - Country:US
Mailing Address - Phone:919-909-7349
Mailing Address - Fax:
Practice Address - Street 1:1150 SE MAYNARD RD STE 220
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4164
Practice Address - Country:US
Practice Address - Phone:919-377-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0208771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical