Provider Demographics
NPI:1407480007
Name:BERTY, JORDAN DORA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:DORA
Last Name:BERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ELIZABETH
Other - Last Name:DORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5310 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1704
Mailing Address - Country:US
Mailing Address - Phone:317-504-8475
Mailing Address - Fax:
Practice Address - Street 1:6100 N KEYSTONE AVE STE 420
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2892
Practice Address - Country:US
Practice Address - Phone:317-296-4914
Practice Address - Fax:317-713-0177
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008763A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical