Healthcare Provider Details

I. General information

NPI: 1154241511
Provider Name (Legal Business Name): JOURDAN GABRIEL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 SAWGRASS CORPORATE PKWY STE 496
SUNRISE FL
33323-2858
US

IV. Provider business mailing address

15029 ARBOR RESERVE CIR APT 104
TAMPA FL
33624-5815
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-7835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW26311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: