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General NPI Number Information
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NPI Number | 1194591701
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Entity Type | Individual
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Provider Name | JORDAN KOTLER LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 766 N 44TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1362
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Country | US
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Telephone | 215-823-8203
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 PENNSYLVANIA AVE APT 212
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3521
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Country | US
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Telephone | 301-793-2316
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | SW138282
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License Number State | PA
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