Provider Demographics
NPI:1316519283
Name:EARLE, JORDAN E (LCSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:E
Last Name:EARLE
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 1:11850 DR MARTIN LUTHER KING JR ST N APT 11310
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1630
Mailing Address - Country:US
Mailing Address - Phone:813-614-5649
Mailing Address - Fax:
Practice Address - Street 1:2525 PASADENA AVE S
Practice Address - Street 2:STE M
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-4556
Practice Address - Country:US
Practice Address - Phone:727-254-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW176631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty