Basic Information
| Provider Information | |||||||||
| NPI: | 1720163595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3075 MYERS ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925035525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513584625 | ||||||||
| FaxNumber: | 9513584901 | ||||||||
| Practice Location | |||||||||
| Address1: | 3075 MYERS ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925035525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513584625 | ||||||||
| FaxNumber: | 9513584901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW 18711 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW28898 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.