Provider Demographics
NPI:1528190436
Name:JORDAN, VICTORIA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:S
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 1:574 W END AVE
Mailing Address - Street 2:#64
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2748
Mailing Address - Country:US
Mailing Address - Phone:212-875-9483
Mailing Address - Fax:212-875-0022
Practice Address - Street 1:574 W END AVE
Practice Address - Street 2:#64
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2748
Practice Address - Country:US
Practice Address - Phone:212-875-9483
Practice Address - Fax:212-875-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0289741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical