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Individual
MARJORIE D JORDAN
Active
Individual
MARJORIE D JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4140
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04178689CL
CLINIC#
—
01
—
118709
VALUE
—
05
—
4014679
—
CT
05
—
4024972
—
CT
Enumeration date
11/20/2006
Last updated
07/09/2007
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