Healthcare Provider Details

I. General information

NPI: 1104898147
Provider Name (Legal Business Name): JORDAN A OSHLAG MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 JAQUES AVE
WORCESTER MA
01610-2476
US

IV. Provider business mailing address

72 JAQUES AVE
WORCESTER MA
01610-2476
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-1163
  • Fax: 508-860-1115
Mailing address:
  • Phone: 508-860-1163
  • Fax: 508-860-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1019357
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: