Provider Demographics
NPI:1366200198
Name:JORDAN A. CONRAD, L.C.S.W., P.C.
Entity type:Organization
Organization Name:JORDAN A. CONRAD, L.C.S.W., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:929-352-0449
Mailing Address - Street 1:1123 BROADWAY STE 308
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2093
Mailing Address - Country:US
Mailing Address - Phone:929-352-0449
Mailing Address - Fax:
Practice Address - Street 1:1123 BROADWAY STE 308
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2093
Practice Address - Country:US
Practice Address - Phone:929-352-0449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty