Provider Demographics
NPI:1952969016
Name:WEISBERGER, JORDAN ROSE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ROSE
Last Name:WEISBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 THAYER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1146
Mailing Address - Country:US
Mailing Address - Phone:301-640-6694
Mailing Address - Fax:
Practice Address - Street 1:68 THAYER ST APT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1146
Practice Address - Country:US
Practice Address - Phone:301-640-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker