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NPI Code Detail

MEDICARE: ADRIENNE ANN JORDAN MSW, LCSW

MEDICARE: ADRIENNE ANN JORDAN MSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerASW 18711CA
21041C0700XClinical Social WorkerLCSW28898CA

General Provider Information

NPI Number : 1720163595
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADRIENNE ANN JORDAN MSW, LCSW
Provider Business Mailing Address
First Line : 3075 MYERS ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-5525
Country : US
Telephone Number : 951-358-4625
Fax Number : 951-358-4901
Provider Business Practice Location Address
First Line : 3075 MYERS ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-5525
Country : US
Telephone Number : 951-358-4625
Fax Number : 951-358-4901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 06/22/2021

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