Provider Demographics
NPI:1245487735
Name:JORDAN, BRENDA (LMSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
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 1:13421 225TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2040
Mailing Address - Country:US
Mailing Address - Phone:718-525-7538
Mailing Address - Fax:718-206-3638
Practice Address - Street 1:16318 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4901
Practice Address - Country:US
Practice Address - Phone:718-206-3440
Practice Address - Fax:718-206-3638
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070886-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical