Healthcare Provider Details

I. General information

NPI: 1649781501
Provider Name (Legal Business Name): JORDAN SCHNEIR BARLAM LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E GILBERT ST
SAN BERNARDINO CA
92415-0911
US

IV. Provider business mailing address

900 E GILBERT ST
SAN BERNARDINO CA
92415-0911
US

V. Phone/Fax

Practice location:
  • Phone: 909-387-7406
  • Fax: 909-387-8610
Mailing address:
  • Phone: 909-387-7406
  • Fax: 909-387-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77619
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number97266
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW97266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: