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General NPI Number Information
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NPI Number | 1083016612
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Entity Type | Individual
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Provider Name | JORDAN ALLAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 5630 VENICE BLVD #1107 VIRTUAL
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City | LOS ANGELES
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State | CA
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Zip | 90019
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Country | US
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Telephone | 818-273-6203
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Fax |
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Provider Business Mailing Address
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Address Line | 5630 VENICE BLVD # 1107
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City | LOS ANGELES
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State | CA
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Zip | 90019-5127
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Country | US
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Telephone | 818-273-6203
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 33012256A
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License Number State | IN
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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 | 110515
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License Number State | CA
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