Provider Demographics
NPI:1063736825
Name:JORDAN, HOLLAND CHASMA (LMSW, MSW)
Entity type:Individual
Prefix:
First Name:HOLLAND
Middle Name:CHASMA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 ARROYO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-9650
Mailing Address - Country:US
Mailing Address - Phone:925-373-4700
Mailing Address - Fax:
Practice Address - Street 1:4951 ARROYO RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9650
Practice Address - Country:US
Practice Address - Phone:925-373-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical