Provider Demographics
NPI:1386412591
Name:BRODY, JORDAN ELIZABETH (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:BRODY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 S OCEAN BLVD APT F11
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7772
Mailing Address - Country:US
Mailing Address - Phone:412-737-2855
Mailing Address - Fax:
Practice Address - Street 1:5301 N FEDERAL HWY STE 270
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4910
Practice Address - Country:US
Practice Address - Phone:954-995-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL205501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty