Jefferson Day Report Center, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

521 Issued in WV

Legal business name

JEFFERSON DAY REPORT CENTER, INC.

Practice address

130 E Burr Blvd FL 1
Kearneysville, WV 25430-4788

Phone

(304) 728-3527

Fax

(304) 728-3614

NPI assigned

Apr 29, 2016

Last updated

Sep 11, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Franklin

Title

Director

Phone

(304) 728-3257

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1790130508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E BURR BLVD FL 1",
            "city": "KEARNEYSVILLE",
            "state": "WV",
            "postal_code": "254304788",
            "telephone_number": "304-728-3527",
            "fax_number": "304-728-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E BURR BLVD FL 1",
            "city": "KEARNEYSVILLE",
            "state": "WV",
            "postal_code": "254304788",
            "telephone_number": "304-728-3527",
            "fax_number": "304-728-3614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON DAY REPORT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-29",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A",
        "authorized_official_last_name": "FRANKLIN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "304-728-3257"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WV",
            "license": "521",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hospice of the Panhandle, Inc.
• Erica M Huffman, M.S.
• Mishika Santosh Jagwani
• Jefferson County Board of Health (Jefferson County Health Department)
• Jefferson County Board of Health (Jefferson County Health Department)
• Alana Johnson
• Jennifer Kerns
• John Allan Krashoc
• Marsha D Krashoc
• Anna Leaker

• Clinical Psychologist in Kearneysville, WV
• Providers in Kearneysville, WV by specialty
• Clinical Psychologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.