Provider Demographics
NPI:1023397387
Name:JORDAN, JAMES RAYMOND (MS, NCC, LMHC,DCC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RAYMOND
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MS, NCC, LMHC,DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-0063
Mailing Address - Country:US
Mailing Address - Phone:631-608-5202
Mailing Address - Fax:631-264-4509
Practice Address - Street 1:595 ROUTE 25A
Practice Address - Street 2:SUITE #15
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2646
Practice Address - Country:US
Practice Address - Phone:631-786-0842
Practice Address - Fax:631-775-9284
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)