Provider Demographics
NPI:1760655609
Name:JORDAN, LAURA MARY (MSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARY
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JORDAN
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2222 PORTOLA LN
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1749
Mailing Address - Country:US
Mailing Address - Phone:805-496-1636
Mailing Address - Fax:
Practice Address - Street 1:2222 PORTOLA LN
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1749
Practice Address - Country:US
Practice Address - Phone:805-496-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical