Healthcare Provider Details

I. General information

NPI: 1326864091
Provider Name (Legal Business Name): JORDAN MARRON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 ROOSEVELT AVE
MONTGOMERY NY
12549-1608
US

IV. Provider business mailing address

38 VAN BURENVILLE RD
MIDDLETOWN NY
10940-7254
US

V. Phone/Fax

Practice location:
  • Phone: 845-325-2921
  • Fax:
Mailing address:
  • Phone: 845-325-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103281
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096193-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: