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General NPI Number Information
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NPI Number | 1356412027
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Entity Type | Individual
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Provider Name | MALYNDA FAYE JORDAN LCSWR CFAE
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 955 E 96TH ST
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City | BROOKLYN
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State | NY
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Zip | 11236-2303
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Country | US
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Telephone | 347-228-3427
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Fax | 718-596-8679
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Provider Business Mailing Address
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Address Line | 955 EAST 96TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11236
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Country | US
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Telephone | 718-257-5867
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Fax | 718-665-1174
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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 | 0539411
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License Number State | NY
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