Active NPI
Jordan Mickens
- Clinical Social Worker
- Chevy Chase, MD
National Provider Identifier
1821757196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 25097
- Practice address
- 4445 Willard Ave
Chevy Chase, MD 20815-3690 - Phone
- (323) 205-7088
- Fax
- (833) 419-0181
- NPI assigned
- Dec 14, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 25097 | MD | Primary |
Addresses
Primary practice location
4445 Willard Ave
Chevy Chase, MD 20815-3690
Mailing address
2929 FM 2920 Rd
Spring, TX 77388-3428
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25097 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765756800000",
"number": "1821757196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 FM 2920 RD",
"city": "SPRING",
"state": "TX",
"postal_code": "773883428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4445 WILLARD AVE",
"city": "CHEVY CHASE",
"state": "MD",
"postal_code": "208153690",
"telephone_number": "323-205-7088",
"fax_number": "833-419-0181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKENS",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-12-14",
"last_updated": "2025-12-15",
"certification_date": "2025-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "25097",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chevy Chase, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.