Provider Demographics
NPI:1093053704
Name:JORDAN, LYNNLEE (EDM, MSW)
Entity Type:Individual
Prefix:MS
First Name:LYNNLEE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:EDM, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HIGHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-2209
Mailing Address - Country:US
Mailing Address - Phone:978-290-1654
Mailing Address - Fax:
Practice Address - Street 1:16 HIGHVIEW RD
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-2209
Practice Address - Country:US
Practice Address - Phone:978-290-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health