Provider Demographics
NPI:1154995009
Name:JORDAN, SHARON HOWETTA
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:HOWETTA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 ALMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1102
Mailing Address - Country:US
Mailing Address - Phone:347-733-6277
Mailing Address - Fax:
Practice Address - Street 1:6918 ALMEDA AVE
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1102
Practice Address - Country:US
Practice Address - Phone:347-733-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0830921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical