Healthcare Provider Details

I. General information

NPI: 1063007466
Provider Name (Legal Business Name): JORDAN ALYSSA KATZ LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OXFORD VALLEY RD STE 601B
YARDLEY PA
19067-7712
US

IV. Provider business mailing address

1504 CHAMPLAIN DR
VOORHEES NJ
08043-2864
US

V. Phone/Fax

Practice location:
  • Phone: 215-337-3993
  • Fax:
Mailing address:
  • Phone: 856-669-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW134421
License Number StatePA

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: