Provider Demographics
NPI:1841965472
Name:FONSECA, JORDAN MARIE (LSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:FONSECA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8474 SUMMERTREE LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3484
Mailing Address - Country:US
Mailing Address - Phone:317-714-7974
Mailing Address - Fax:
Practice Address - Street 1:970 LOGAN ST STE 110
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2253
Practice Address - Country:US
Practice Address - Phone:317-760-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker