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NPI Code Detail

MEDICARE: MS. LIDIA U. JORDAN CASAC-T

MEDICARE:  MS. LIDIA U. JORDAN  CASAC-T
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
1101YA0400XAddiction (Substance Use Disorder) Counselor21384NY

General Provider Information

NPI Number : 1396079497
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LIDIA U. JORDAN CASAC-T
Provider Business Mailing Address
First Line : 270 S BROOKSIDE AVE
Second Line :
City : FREEPORT
State : NY
Zip : 11520-4140
Country : US
Telephone Number : 516-538-2613
Fax Number : 516-538-0772
Provider Business Practice Location Address
First Line : 344 FULTON AVE
Second Line :
City : HEMPSTEAD
State : NY
Zip : 11550-3923
Country : US
Telephone Number : 516-538-2613
Fax Number : 516-538-0772
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2009
Last Update Date : 09/23/2009

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Directions to “ MS. LIDIA U. JORDAN CASAC-T” Practice Location

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