Provider Demographics
NPI:1093071490
Name:JORDAN-PARKER, LINDA MARY (EDD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARY
Last Name:JORDAN-PARKER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BRACE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1420
Mailing Address - Country:US
Mailing Address - Phone:860-819-1088
Mailing Address - Fax:855-949-3706
Practice Address - Street 1:11 BRACE RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1420
Practice Address - Country:US
Practice Address - Phone:860-819-1088
Practice Address - Fax:855-949-3706
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CT003041103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical