MEDICARE: MRS. DARLENE PAPA 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	101Y00000X	Counselor	Q1-0000749	DE

General Provider Information

NPI Number	:	1235116930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARLENE PAPA JORDAN LCSW

Provider Business Mailing Address
First Line	:	1500 SHALLCROSS AVE
Second Line	:	STE 2
City	:	WILMINGTON
State	:	DE
Zip	:	19806-3037
Country	:	US
Telephone Number	:	302-743-2984
Fax Number	:	302-326-0664

Provider Business Practice Location Address
First Line	:	1500 SHALLCROSS AVE
Second Line	:	STE 2
City	:	WILMINGTON
State	:	DE
Zip	:	19806-3037
Country	:	US
Telephone Number	:	302-743-2984
Fax Number	:	302-326-0664

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	01/14/2014

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