Provider Demographics
NPI:1407906761
Name:JORDAN, MARYBETH CURRAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:CURRAN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 W 74TH ST
Mailing Address - Street 2:APT. 8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2141
Mailing Address - Country:US
Mailing Address - Phone:917-684-5039
Mailing Address - Fax:
Practice Address - Street 1:2 W 86TH ST
Practice Address - Street 2:SUITE 505
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3666
Practice Address - Country:US
Practice Address - Phone:212-726-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR059527-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical