Provider Demographics
NPI:1447602867
Name:JORDAN, DENISE MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
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 1:18915 37TH AVE
Mailing Address - Street 2:#R
Mailing Address - City:AUBURNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2495
Mailing Address - Country:US
Mailing Address - Phone:718-747-5241
Mailing Address - Fax:718-747-5241
Practice Address - Street 1:18915 37TH AVE
Practice Address - Street 2:#R
Practice Address - City:AUBURNDALE
Practice Address - State:NY
Practice Address - Zip Code:11358-2495
Practice Address - Country:US
Practice Address - Phone:718-747-5241
Practice Address - Fax:718-747-5241
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0937961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical