Provider Demographics
NPI:1174689269
Name:JORDAN, MARION PEALE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:PEALE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HILLSIDE ST
Mailing Address - Street 2:CORRIGAN MENTAL HEALTH CENTER
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5211
Mailing Address - Country:US
Mailing Address - Phone:508-235-7277
Mailing Address - Fax:508-235-7345
Practice Address - Street 1:49 HILLSIDE ST
Practice Address - Street 2:CORRIGAN MENTAL HEALTH CENTER
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5211
Practice Address - Country:US
Practice Address - Phone:508-235-7277
Practice Address - Fax:508-235-7345
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJO-P23908Medicare ID - Type Unspecified