Provider Demographics
NPI:1053477349
Name:JORDAN, ROBERT H (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W. TYRONE ROAD
Mailing Address - Street 2:RIDGEVIEW PSYCHIATRIC HOSPITAL AND OUTPATIENT CENTER
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-0000
Mailing Address - Country:US
Mailing Address - Phone:865-481-6170
Mailing Address - Fax:865-483-6697
Practice Address - Street 1:240 W. TYRONE ROAD
Practice Address - Street 2:RIDGEVIEW PSYCHIATRIC HOSPITAL AND OUTPATIENT CENTER
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-0000
Practice Address - Country:US
Practice Address - Phone:865-481-6170
Practice Address - Fax:865-483-6697
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TN5338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker