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General NPI Number Information
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NPI Number | 1235757089
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Entity Type | Individual
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Provider Name | JORDAN MICHAEL FRIEDMAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 4220 N 20TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85015-5124
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Country | US
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Telephone | 602-889-9401
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Fax |
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Provider Business Mailing Address
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Address Line | 7724 E CAMELBACK RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-2228
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Country | US
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Telephone | 847-630-7654
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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 | LCSW-18586
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License Number State | AZ
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