Provider Demographics
NPI:1073373262
Name:ROE, JORDAN MARISA (BA, MA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARISA
Last Name:ROE
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3332
Mailing Address - Country:US
Mailing Address - Phone:267-255-2813
Mailing Address - Fax:
Practice Address - Street 1:245 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3332
Practice Address - Country:US
Practice Address - Phone:267-255-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor