Provider Demographics
NPI:1063007466
Name:KATZ, JORDAN ALYSSA (LSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALYSSA
Last Name:KATZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2864
Mailing Address - Country:US
Mailing Address - Phone:856-669-7444
Mailing Address - Fax:
Practice Address - Street 1:301 OXFORD VALLEY RD STE 601B
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7712
Practice Address - Country:US
Practice Address - Phone:215-337-3993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty