Provider Demographics
NPI:1013162015
Name:JORDAN, NAZLY (LMSW,)
Entity Type:Individual
Prefix:
First Name:NAZLY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMSW,
Other - Prefix:
Other - First Name:NAZLY
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:3520 35TH ST
Mailing Address - Street 2:B33
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3520 35TH ST
Practice Address - Street 2:B33
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1606
Practice Address - Country:US
Practice Address - Phone:718-482-0983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066358-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker