Individual ProviderJefferson TaverasSocial WorkerBehavioral Health & Social Service ProvidersPractice Address255 Gordon St, Staten Island, NY 10304-1943(888) 554-3810PECOS EnrollmentBased on the most recent information from CMS, provider Jefferson Taveras does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1619212883Provider TypeIndividualFull NameTaveras, JeffersonCredentialLCSWGenderMaleSole ProprietorYesEnumeration Date11/29/2012Last Updated11/29/2012Contact InformationPractice LocationPractice Address255 Gordon St, Staten Island, NY 10304-1943Phone(888) 554-3810Fax(206) 426-0930Mailing LocationMailing Address255 Gordon St, Staten Island, NY 10304-1943Phone(888) 554-3810Fax(206) 426-0930Provider TaxonomiesCodeDescriptionLicenseCode104100000XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer