Healthcare Provider Details

I. General information

NPI: 1891440475
Provider Name (Legal Business Name): JEFFREY LEE JORDY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25A LIME KILN RD
LAMY NM
87540-9657
US

IV. Provider business mailing address

25A LIME KILN RD
LAMY NM
87540-9657
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-1113
  • Fax:
Mailing address:
  • Phone: 505-585-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019267
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137520
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC25356
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12097
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021943
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: