Provider Demographics
NPI:1184762700
Name:JORDAN, CHARLOTTE FAUCI (LMFT)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:FAUCI
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ODESSA CT
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-4420
Mailing Address - Country:US
Mailing Address - Phone:650-363-0981
Mailing Address - Fax:650-364-9954
Practice Address - Street 1:617 VETERANS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1496
Practice Address - Country:US
Practice Address - Phone:650-261-0111
Practice Address - Fax:650-364-9954
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMF20558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist