Provider Demographics
NPI:1578767000
Name:JORDAN, CASSANDRA H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:H
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:D
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:701 94TH AVE N STE 250
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2448
Mailing Address - Country:US
Mailing Address - Phone:727-321-3854
Mailing Address - Fax:727-327-7670
Practice Address - Street 1:18167 US HIGHWAY 19 N STE 150
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6566
Practice Address - Country:US
Practice Address - Phone:727-321-3854
Practice Address - Fax:727-321-7670
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053731041C0700X
FLSW127901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113400700Medicaid