Provider Demographics
NPI:1083016612
Name:ALLAN, JORDAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:
Last Name:ALLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 VENICE BLVD # 1107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5127
Mailing Address - Country:US
Mailing Address - Phone:818-273-6203
Mailing Address - Fax:
Practice Address - Street 1:5630 VENICE BLVD #1107
Practice Address - Street 2:VIRTUAL
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019
Practice Address - Country:US
Practice Address - Phone:818-273-6203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33012256A1041C0700X
CA1105151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical