Healthcare Provider Details

I. General information

NPI: 1942857974
Provider Name (Legal Business Name): JORDAN ALLENE BERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE STE 440
WASHINGTON DC
20003-4424
US

IV. Provider business mailing address

326 15TH ST SE UNIT 1A
WASHINGTON DC
20003-2340
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5440
  • Fax:
Mailing address:
  • Phone: 314-532-6254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG50083046
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: