Healthcare Provider Details

I. General information

NPI: 1821873647
Provider Name (Legal Business Name): JORDAN GARDNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MACARTHUR BLVD
OAKLAND CA
94605-5298
US

IV. Provider business mailing address

2239 9TH ST
BERKELEY CA
94710-2321
US

V. Phone/Fax

Practice location:
  • Phone: 510-853-3520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: