MEDICARE: JORDAN ROSENBLUTH

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
1	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker	SWB-2023-0994	NM
3	104100000X	Social Worker	110666	TX
4	1041C0700X	Clinical Social Worker	SWB-2025-1321	NM

General Provider Information

NPI Number	:	1831593748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ROSENBLUTH

Provider Business Mailing Address
First Line	:	4656 VALENTINA RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0855
Country	:	US
Telephone Number	:	828-772-0128
Fax Number	:	828-772-0128

Provider Business Practice Location Address
First Line	:	4656 VALENTINA RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-0855
Country	:	US
Telephone Number	:	828-772-0128
Fax Number	:	828-772-0128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	12/05/2025

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Directions to “ JORDAN ROSENBLUTH ” Practice Location

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