Provider Demographics
NPI:1831463348
Name:JORDAN, IDELL SANCHEZ (LMSW, MSW)
Entity Type:Individual
Prefix:
First Name:IDELL
Middle Name:SANCHEZ
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3588
Mailing Address - Country:US
Mailing Address - Phone:504-361-6026
Mailing Address - Fax:504-361-6254
Practice Address - Street 1:4422 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3588
Practice Address - Country:US
Practice Address - Phone:504-361-6026
Practice Address - Fax:504-361-6254
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical