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General NPI Number Information
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NPI Number | 1679173272
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Entity Type | Individual
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Provider Name | JORDANNA BLAKE GARREN LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/01/2020
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 400 COMMUNITY DR
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City | MANHASSET
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State | NY
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Zip | 11030-3815
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Country | US
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Telephone | 516-562-3356
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Fax |
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Provider Business Mailing Address
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Address Line | 40 GREYBARN LN APT 319
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City | AMITYVILLE
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State | NY
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Zip | 11701-2265
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Country | US
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Telephone | 516-317-7329
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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 | 097575-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 114651-01
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License Number State | NY
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