MEDICARE: DR. CHRISTIAN JORDAL PH.D., LMFT

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	106H00000X	Marriage & Family Therapist	MF000699	PA

General Provider Information

NPI Number	:	1801122650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN JORDAL PH.D., LMFT

Provider Business Mailing Address
First Line	:	628 S BROAD ST
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1614
Country	:	US
Telephone Number	:	484-429-6079
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 S BROAD ST
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1614
Country	:	US
Telephone Number	:	484-429-6079
Fax Number	:

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

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	01/21/2015

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