Individual
BRIAN KEITH JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
300 CENTER DR FL 2, RIVERHEAD, NY 11901-3393
(631) 852-2680
Mailing address
2802 CONNECTICUT AVE, MEDFORD, NY 11763-1913
(631) 902-2481
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1053721
NY
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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