Provider Demographics
NPI:1164161790
Name:JORDAN ZIPKIN PA
Entity Type:Organization
Organization Name:JORDAN ZIPKIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-881-0593
Mailing Address - Street 1:2930 BARNARD ST UNIT 17101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5763
Mailing Address - Country:US
Mailing Address - Phone:619-881-0593
Mailing Address - Fax:
Practice Address - Street 1:3344 4TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5704
Practice Address - Country:US
Practice Address - Phone:619-881-0593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)