Provider Demographics
NPI:1164186953
Name:JORDAN, AMINA NIA
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:NIA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMINA
Other - Middle Name:NIA
Other - Last Name:JORDAN-MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 OCONNOR AVE
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3315
Mailing Address - Country:US
Mailing Address - Phone:413-461-6530
Mailing Address - Fax:
Practice Address - Street 1:26 S PROSPECT ST STE 204
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2252
Practice Address - Country:US
Practice Address - Phone:413-591-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker