Provider Demographics
NPI:1962695338
Name:JORDAN, MICHAEL CHRISTOPHER (MSS, LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5429 VICARIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2823
Mailing Address - Country:US
Mailing Address - Phone:267-581-1977
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD STE 318
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3709
Practice Address - Country:US
Practice Address - Phone:215-885-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0157841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical