Provider Demographics
NPI:1326425299
Name:JORDAN, LAKIA (LMSW)
Entity Type:Individual
Prefix:
First Name:LAKIA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LENOX AVE APT 14D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-4514
Mailing Address - Country:US
Mailing Address - Phone:212-234-7366
Mailing Address - Fax:
Practice Address - Street 1:700 LENOX AVE APT 14D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4514
Practice Address - Country:US
Practice Address - Phone:212-234-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091524-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency