Provider Demographics
NPI:1770049116
Name:NODELMAN, JORDAN MATTHEW (LCSW, LICSW, BCD)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:MATTHEW
Last Name:NODELMAN
Suffix:
Gender:M
Credentials:LCSW, LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 CORDOVA RD # 152
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2157
Mailing Address - Country:US
Mailing Address - Phone:754-300-6990
Mailing Address - Fax:
Practice Address - Street 1:1881 NE 26TH ST STE 212F
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1400
Practice Address - Country:US
Practice Address - Phone:754-946-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000016051041C0700X
VT089.0136286TELE1041C0700X
VA09040127731041C0700X
FLSW180581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical