Provider Demographics
NPI:1194591701
Name:KOTLER, JORDAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:
Last Name:KOTLER
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 1:2201 PENNSYLVANIA AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3521
Mailing Address - Country:US
Mailing Address - Phone:301-793-2316
Mailing Address - Fax:
Practice Address - Street 1:766 N 44TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1362
Practice Address - Country:US
Practice Address - Phone:215-823-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1382821041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool