MEDICARE: JORDAN ELLMAN ASW #126366

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	126366	CA

General Provider Information

NPI Number	:	1639978604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ELLMAN ASW #126366

Provider Business Mailing Address
First Line	:	5350 MACHADO ROAD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5350 MACHADO ROAD
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-9023
Country	:	US
Telephone Number	:	310-204-3300
Fax Number	:

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

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	03/11/2025

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