Individual provider Active NPI

Joyce Taylor Jordan, LISW-S, LICDC, SAP

  • Clinical Social Worker
  • Lakewood, OH
National Provider Identifier
1417983354
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I0009384 Issued in OH
Practice address
14650 Detroit Avenue
Suite #LL30
Lakewood, OH 44107
Phone
(216) 226-2721
Fax
(216) 226-2731
NPI assigned
Jun 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X I-0009384 OH
Clinical Social Worker 1041C0700X I0009384 OH Primary
Clinical Social Worker 1041C0700X 954355 OH

Addresses

Primary practice location

14650 Detroit Avenue
Suite #LL30
Lakewood, OH 44107

Mailing address

14650 Detroit Avenue
Suite #LL40
Lakewood, OH 44107
Phone (216) 226-2721

Other identifiers 1

IdentifierTypeStateIssuer
2632431MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
954355OHMDClinical Social Worker
I-0009384OHMDClinical Social Worker
I0009384OHMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1417983354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14650 DETROIT AVENUE",
            "address_2": "SUITE #LL40",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "44107",
            "telephone_number": "216-226-2721",
            "fax_number": "216-226-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14650 DETROIT AVENUE",
            "address_2": "SUITE #LL30",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "44107",
            "telephone_number": "216-226-2721",
            "fax_number": "216-226-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "JOYCE",
        "middle_name": "TAYLOR",
        "name_prefix": "Mrs.",
        "credential": "LISW-S, LICDC, SAP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-0009384",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I0009384",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "954355",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2632431",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.