Provider Demographics
NPI:1871014811
Name:JORGENSEN, ELIANA (LCSW)
Entity type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 WILLIAM PENN HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1887
Mailing Address - Country:US
Mailing Address - Phone:315-378-9455
Mailing Address - Fax:
Practice Address - Street 1:4115 WILLIAM PENN HWY STE 201
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1887
Practice Address - Country:US
Practice Address - Phone:724-733-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0254101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW133624OtherLICENSE