Provider Demographics
NPI:1255784740
Name:ANDERSON, JORDON DENISE (LICSW, CST)
Entity type:Individual
Prefix:MRS
First Name:JORDON
Middle Name:DENISE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LICSW, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 HANCOCK ST STE 205
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4371
Mailing Address - Country:US
Mailing Address - Phone:405-435-2449
Mailing Address - Fax:
Practice Address - Street 1:1212 HANCOCK ST STE 205
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4371
Practice Address - Country:US
Practice Address - Phone:617-750-0183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker