MEDICARE: JENNIFER JORDAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	MC17274	ME

General Provider Information

NPI Number	:	1134687890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JORDAN LCSW

Provider Business Mailing Address
First Line	:	81 DRAGON FLY DR
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-3064
Country	:	US
Telephone Number	:	207-381-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 DRAGON FLY DR
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-3064
Country	:	US
Telephone Number	:	207-381-7101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	07/26/2024

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