Provider Demographics
NPI:1598903890
Name:JORDAN, PAMELA DARLENE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:DARLENE
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 1:1889 SEDGWICK AVE
Mailing Address - Street 2:SUITE 9G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-5009
Mailing Address - Country:US
Mailing Address - Phone:347-306-7710
Mailing Address - Fax:
Practice Address - Street 1:1889 SEDGWICK AVE
Practice Address - Street 2:SUITE 9G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5009
Practice Address - Country:US
Practice Address - Phone:347-306-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070819104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker