Healthcare Provider Details

I. General information

NPI: 1326493735
Provider Name (Legal Business Name): JORDAN J RAMIREZ LCSW-10619-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN J HOLBROOK

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 OPAL DR UNIT G200
ELKO NV
89801-3452
US

IV. Provider business mailing address

PO BOX 1246
CARLIN NV
89822
US

V. Phone/Fax

Practice location:
  • Phone: 775-385-4479
  • Fax:
Mailing address:
  • Phone: 775-385-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10619-C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: