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General NPI Number Information
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NPI Number | 1023560208
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Entity Type | Individual
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Provider Name | LYDIA JORDAN LCSW, LCADC
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Gender | Female
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 1 BROOKFIELD GLEN DR
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City | BELVIDERE
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State | NJ
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Zip | 07823-2854
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Country | US
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Telephone | 908-652-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BROOKFIELD GLEN DR
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City | BELVIDERE
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State | NJ
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Zip | 07823-2854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00277200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05682400
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License Number State | NJ
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